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Lei Y, Zeng Y, Li Z, Xiao Z, Tang G, Liu Y, Xiao C, Luo M, Yan H, Chen H, Wang X. Risk factors for infection in patients undergoing knee arthroscopy: a systematic review and meta-analysis. J Hosp Infect 2025; 155:170-184. [PMID: 38992840 DOI: 10.1016/j.jhin.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/14/2024] [Accepted: 06/16/2024] [Indexed: 07/13/2024]
Abstract
The primary aim of this study was to determine the risk of infection after knee arthroscopy and to evaluate the risk factors for surgical site infection (SSI). The PubMed/Medline, Embase and Cochrane Library databases were systematically searched, as were the reference lists of previous systematic reviews and meta-analysis manual studies. A random-effects model was used to calculate the estimated pooled odds ratio (OR). A total of 38,321 potential articles met the initial inclusion criteria. After a review of the titles, abstracts and full texts, the remaining 41 articles were included in the final analysis. We identified 9,089,578 patients who underwent knee arthroscopy in 41 articles. High-quality (class I) evidence showed that autografts (cruciate ligament reconstruction) (OR, 2.66;95% CI, 1.84-3.86) or high procedure complexity (OR, 2.02; 95% CI, 1.69-2.43) had a higher risk of infection, while medium-quality (class II or class III) evidence showed that obesity (body mass index ≥30 kg/m2) (OR, 1.27; 95% CI, 1.08-1.49) or male (OR, 1.52; 95% CI, 1.32-1.75) or diabetes (OR, 1.71; 95% CI, 1.36-2.14) or tobacco use (OR, 1.65; 95% CI, 1.38-1.97) or preoperative steroid use (OR, 3.41; 95% CI, 2.10-5.54) had a higher risk of infection. The meta-analysis showed that there was no association between age or antibiotic prophylaxis and infection incidence. The meta-analysis showed that significant risk factors for infection after knee arthroscopy included obesity, male sex, diabetes, tobacco use, high procedure complexity, graft type, and preoperative steroid use.
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Affiliation(s)
- Y Lei
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Y Zeng
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Z Li
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Z Xiao
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - G Tang
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Y Liu
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - C Xiao
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - M Luo
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - H Yan
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - H Chen
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - X Wang
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China.
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Zhang L, Yang R, Mao Y, Fu W. A Systematic Review and Meta-analysis of Risk Factors for an Infection After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2023; 11:23259671231200822. [PMID: 37846316 PMCID: PMC10576935 DOI: 10.1177/23259671231200822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/19/2023] [Indexed: 10/18/2023] Open
Abstract
Background Identifying risk factors for an infection after anterior cruciate ligament reconstruction (ACLR) and following targeted preventive strategies can effectively reduce this potentially serious complication. Purpose To perform a systematic review and meta-analysis to identify the risk factors for an infection after ACLR. Study Design Systematic review; Level of evidence, 4. Methods The PubMed, Embase, and Web of Science databases were searched from inception to September 1, 2022, for prospective and retrospective studies investigating risk factors for any type of infection after ACLR. Odds ratios (ORs) or mean differences were calculated for potential risk factors if ≥2 studies assessed the same risk factor. A qualitative analysis of variables was performed if a meta-analysis could not be conducted. Results A total of 17 studies with 141,991 patients were included in this review. The overall pooled infection rate was 0.86% (range, 0.24%-5.50%). There were 20 risk factors identified for analysis. Of these, 7 variables independently increased the odds of an infection after ACLR: (1) male sex (OR, 1.90 [95% CI, 1.33-2.73]), (2) diabetes (OR, 2.69 [95% CI, 1.66-4.35]), (3) hamstring tendon autograft (OR, 2.51 [95% CI, 2.03-3.10]), (4) revision ACLR (OR, 2.31 [95% CI, 1.22-4.37]), (5) professional athlete status (OR, 6.21 [95% CI, 1.03-37.38]), (6) lateral tenodesis (OR, 3.45 [95% CI, 1.63-7.28]), and (7) corticosteroid use (OR, 7.83 [95% CI, 3.68-16.63]). No significant associations were found between postoperative infections and age, body mass index, smoking, meniscal repair, or outpatient surgery. Conclusion This review revealed that an increased risk of infections after ACLR was associated with male sex, diabetes, hamstring tendon autograft, revision surgery, professional athlete status, lateral tenodesis, and steroid use. Knowledge of the risk factors associated with an infection after ACLR may facilitate the identification of high-risk cases and the implementation of preventive measures to mitigate the serious consequences of this complication.
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Affiliation(s)
- Lei Zhang
- Orthopedics Research Institute, Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Runze Yang
- Orthopedics Research Institute, Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yunhe Mao
- Orthopedics Research Institute, Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Weili Fu
- Orthopedics Research Institute, Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Zhao D, Liang GH, Pan JK, Zeng LF, Luo MH, Huang HT, Han YH, Lin FZ, Xu NJ, Yang WY, Liu J. Risk factors for postoperative surgical site infections after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Br J Sports Med 2023; 57:118-128. [PMID: 36517215 PMCID: PMC9872252 DOI: 10.1136/bjsports-2022-105448] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The primary aim was to evaluate risk factors for surgical site infections after anterior cruciate ligament reconstruction (ACLR). The secondary aim was to investigate the surgical site infection incidence rate and the mean time to postoperative surgical site infection symptoms. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase and Web of Science were searched from database inception to September 2021 and updated in April 2022. ELIGIBILITY CRITERIA Quantitative, original studies reporting potential risk factors for surgical site infections after ACLR were included. RESULTS Twenty-three studies with 3871 infection events from 469 441 ACLRs met the inclusion criteria. Male sex (OR 1.78, p< 0.00001), obesity (OR 1.82, p=0.0005), tobacco use (OR 1.37, p=0.01), diabetes mellitus (OR 3.40, p=0.002), steroid use history (OR 4.80, p<0.00001), previous knee surgery history (OR 3.63, p=0.02), professional athlete (OR 4.56, p=0.02), revision surgery (OR 2.05, p=0.04), hamstring autografts (OR 2.83, p<0.00001), concomitant lateral extra-articular tenodesis (OR 3.92, p=0.0001) and a long operating time (weighted mean difference 8.12, p=0.005) were identified as factors that increased the risk of surgical site infections (superficial and deep) after ACLR. Age, outpatient or inpatient surgery, bone-patellar tendon-bone autografts or allografts and a concomitant meniscus suture did not increase the risk of surgical site infections. The incidence of surgical site infections after ACLR was approximately 1% (95% CI 0.7% to 1.2%). The mean time from surgery to the onset of surgical site infection symptoms was approximately 17.1 days (95% CI 13.2 to 21.0 days). CONCLUSION Male sex, obesity, tobacco use, diabetes mellitus, steroid use history, previous knee surgery history, professional athletes, revision surgery, hamstring autografts, concomitant lateral extra-articular tenodesis and a long operation time may increase the risk of surgical site infections after ACLR. Although the risk of surgical site infections after ACLR is low, raising awareness and implementing effective preventions for risk factors are priorities for clinicians to reduce the incidence of surgical site infections due to its seriousness.
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Affiliation(s)
- Di Zhao
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China
| | - Gui-Hong Liang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jian-Ke Pan
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ling-Feng Zeng
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ming-Hui Luo
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - He-Tao Huang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yan-Hong Han
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Fang-Zheng Lin
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China
| | - Nan-Jun Xu
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China
| | - Wei-Yi Yang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jun Liu
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China
- Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Enginering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China
- The fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
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Pullen WM, Money AJ, Ray TE, Freehill MT, Sherman SL. Postoperative Infection: Prevention, Diagnosis, and Treatment Guidelines for the Sports Surgeon. Sports Med Arthrosc Rev 2022; 30:17-23. [PMID: 35113838 DOI: 10.1097/jsa.0000000000000335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Postoperative infection remains a potentially devastating complication facing the sports medicine surgeon. Infection prevention begins with a thorough history and physical examination to identify patient specific risk factors and aid in risk stratification. Perioperative steroid injections should be used cautiously, with increased time prior to or following surgery being associated with lower infection risk. Sterile preparation with an alcohol containing solution is typically preferred, though there is limited evidence to identify which product is superior. Diagnosis can be challenging with a high index of suspicion needed to identify and appropriately manage patients. Treatment involves prompt irrigation and debridement with deep cultures. Antibiotic coverage should begin with empiric broad treatment and be tailored based on culture results. Early consultation with an infectious disease specialist is recommended to ensure appropriate antibiotic coverage and duration of treatment.
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Affiliation(s)
- W Michael Pullen
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC
| | - Adam J Money
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, PA
| | - Taylor E Ray
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA
| | | | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA
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Stetter J, Boge GS, Grönlund U, Bergström A. Risk factors for surgical site infection associated with clean surgical procedures in dogs. Res Vet Sci 2021; 136:616-621. [PMID: 33905955 DOI: 10.1016/j.rvsc.2021.04.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/13/2021] [Accepted: 04/12/2021] [Indexed: 11/26/2022]
Abstract
Surgical site infection (SSI) is associated with increased morbidity, cost and mortality in human medicine and with increased morbidity and cost in veterinary medicine. The aim of this study was to evaluate risk factors for SSI development after clean surgical procedures in dogs, treated at both first opinion clinics as well as referral hospitals. 1550 dogs scored 1 or 2 according to the American Society of Anesthesiologists (ASA), that underwent clean surgical procedures at 103 clinics located in Northern and Central Europe were included in the study. Data regarding the surgical procedure, surgery time use of perioperative antimicrobial prophylaxis (AMP), surgery type, intraoperative hypothermia, and the use of surgical implants were recorded according to predefined protocols. Active 30-day SSI surveillance was performed. A random effects logistic regression model was used to evaluate the association between the perioperative variables and SSI development. SSI was detected in 85/1550 dogs (5.5%); 25 occurred in the 500 orthopedic/neurosurgery procedures (5.0%), and 60 in the 1050 soft tissue procedures (5.7%). A total of 1524 dogs were included in the final multivariable model. Increased surgery time was the only variable associated with an increased risk of SSI. No association between the other risk factors evaluated in the study and SSI occurrence was detected. Efforts must therefore be made to keep the surgery time as short as possible. Orthopedic and neurosurgical procedures including those where an implant is placed should not automatically be regarded as high-risk procedures benefiting from perioperative AMP.
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Affiliation(s)
- J Stetter
- Anicura Läckeby Small Animal Hospital, Kalmar, Sweden.
| | - G S Boge
- Norwegian University of Life Sciences, Faculty of Veterinary Medicine, Department of Clinical Sciences, Oslo, Norway
| | | | - A Bergström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Sweden
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Baron JE, Shamrock AG, Cates WT, Cates RA, An Q, Wolf BR, Bollier MJ, Duchman KR, Westermann RW. Graft Preparation with Intraoperative Vancomycin Decreases Infection After ACL Reconstruction: A Review of 1,640 Cases. J Bone Joint Surg Am 2019; 101:2187-2193. [PMID: 31609893 DOI: 10.2106/jbjs.19.00270] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reported infection rates following anterior cruciate ligament (ACL) reconstruction are low, but infections are associated with high morbidity including reoperations and inferior clinical outcomes. The purpose of the current study was to investigate the rate of infection after ACL reconstruction with and without graft preparation with a vancomycin irrigant. METHODS All ACL reconstructions performed between May 2009 and August 2018 at a single academic institution were reviewed and categorized based on vancomycin use. Patients with <90-day follow-up, intraoperative graft preparation with an antibiotic other than vancomycin, or previous ipsilateral knee infection were excluded. Infection was defined as a return to the operating room for irrigation and debridement within 90 days after ACL reconstruction. Descriptive and inferential statistical analysis using t tests and Poisson regression were performed, with significance defined as p < 0.05. RESULTS In total, 1,640 patients (952 males; 58.0%) with a mean age (and standard deviation) of 27.7 ± 11.4 years underwent ACL reconstruction (1,379 primary procedures; 84.1%) and were included for analysis. Intraoperative vancomycin was used in 798 cases (48.7%), whereas 842 ACL reconstructions (51.3%) were performed without intraoperative vancomycin. In total, 11 reconstructions (0.7%) were followed by infection, which occurred in 10 (1.2%) of the patients in whom the graft was not soaked in vancomycin and in 1 (0.1%) of the patients in whom the graft was soaked in vancomycin (p = 0.032). Age (p = 0.571), sex (p = 0.707), smoking (p = 0.407), surgeon (p = 0.124), and insurance type (p = 0.616) were not associated with postoperative infection risk. Autograft use was associated with decreased infections (p = 0.045). There was an 89.4% relative risk reduction with the use of intraoperative vancomycin. An increased body mass index (BMI) (p = 0.029), increased operative time (p = 0.001), and the absence of ACL graft preparation with vancomycin (p = 0.032) independently predicted postoperative infection. CONCLUSIONS The use of vancomycin-soaked grafts was associated with a 10-fold reduction in infection after ACL reconstruction (0.1% versus 1.2%; p = 0.032). Other risk factors for infection after ACL reconstruction included increased BMI and increased operative time. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- J E Baron
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
| | - A G Shamrock
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
| | - W T Cates
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
| | - R A Cates
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
| | - Q An
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
| | - B R Wolf
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
| | - M J Bollier
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
| | - K R Duchman
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
| | - R W Westermann
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
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Value of antibiotic prophylaxis in routine knee arthroscopy : A retrospective study. DER ORTHOPADE 2019; 47:246-253. [PMID: 28993891 DOI: 10.1007/s00132-017-3486-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Prophylactic antibiotic use prior to routine knee arthroscopy remains controversial. It is important to know whether antibiotics help decrease the surgical site infection (SSI) rate. Our aims were to assess the efficacy of antibiotic prophylaxis in preventing SSI and to identify risk factors for SSI following routine knee arthroscopy without an implant. METHODS A retrospective study was conducted using the electronic medical records at the authors' hospital to identify patients that underwent routine knee arthroscopy without an implant between October 2010 and October 2016. Data on demographics, clinical characteristics and antibiotic administration were extracted. Arthroscopic diagnosis, debridement, partial or complete meniscectomy, arthroscopic shaving and microfracture, removal of loose bodies, synovectomy and lateral retinacular release were included. Complex knee arthroscopy with an implant was excluded. Patients were divided into evaluation (with prophylactic antibiotics) and control (no antibiotic treatment) groups. Continuous variables between groups were compared using the Student's t-test. Data were analyzed using the Chi-squared test for percentages between groups. Multivariate logistic regression was used to identify independent risk factors of SSI. RESULTS Of 1326 patients, 614 (46.3%) received prophylactic antibiotics, while 712 (53.7%) did not. There were seven (0.53%) SSIs. The SSI rate did not differ significantly between patients receiving antibiotics (0.49%, three) and those not (0.56%, four). Five patients (0.37%) had superficial infections, two (0.33%) were in the prophylactic antibiotic group and three (0.42%) were in the other group. Deep infections occurred in two patients (0.15%), one (0.16%) in the prophylactic antibiotic group and one (0.14%) in the other group. The difference between the two groups was not statistically significant (P = 1.0). Age over 50 years was associated with an increased risk of SSI (relative ratio [RR] = 1.469, 95% confidence interval [CI] 1.09-2.13, P = 0.009). CONCLUSIONS Prophylactic antibiotic use in routine knee arthroscopy without an implant may not be necessary. Age over 50 years was associated with an increased risk of SSI.
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Lai MC, Yeo W, Tan AHC. The incidence of infection in routine knee arthroscopy without the use of prophylactic antibiotics is low. PROCEEDINGS OF SINGAPORE HEALTHCARE 2019. [DOI: 10.1177/2010105818822588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background:The use of prophylactic antibiotics in routine knee arthroscopy remains prevalent despite previous evidence suggesting that it may not be necessary, and may indeed carry more risks than benefits. This study aims to determine the incidence of surgical site infections in patients undergoing routine knee arthroscopy without prophylactic antibiotics.Methods:This is a retrospective review of 553 consecutive patients who underwent routine knee arthroscopy from 2004 to 2013 by a single fellowship-trained sports surgeon in a single institution. The spectrum of cases included arthroscopic meniscectomy, meniscal repair, microfracture, chondroplasty, removal of loose bodies and lateral retinacular release. No patient received any prophylactic antibiotics. Patient demographics and comorbidities were reviewed and all patients were followed up postoperatively for a minimum of two years. All postoperative complications were recorded.Results:There were 349 male and 204 female patients. The mean age was 41.8 years (SD 14.8) and mean operative time was 30.4 minutes (SD 12.3). Two healthy young patients developed postoperative superficial wound infection within one week after surgery, but recovered with outpatient oral antibiotic treatment. The overall infection rate was 0.36%. No cases of deep infection were reported.Conclusion:This study showed a very low rate of surgical site infections, comparable with known rates following such operations. This suggests that prophylactic antibiotics are not necessary and avoids the known risks associated with their use.
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Affiliation(s)
- Mun Chun Lai
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - William Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Kawata M, Sasabuchi Y, Taketomi S, Inui H, Matsui H, Fushimi K, Yasunaga H, Tanaka S. Atopic dermatitis is a novel demographic risk factor for surgical site infection after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:3699-3705. [PMID: 29725748 DOI: 10.1007/s00167-018-4958-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 04/23/2018] [Indexed: 01/13/2023]
Abstract
PURPOSE Although various risk factors for surgical site infection after anterior cruciate ligament reconstruction (ACLR) have been reported, the number of studies with large sample sizes on this topic is limited. The aim of the present study was to clarify the risk factors for early surgical site infection after ACLR in a large cohort using a national database in Japan. METHODS The data of patients who underwent ACLR from 2010 to 2015 were obtained from the Diagnosis Procedure Combination database, which covers approximately half of all hospital admissions in Japan. The outcome measures were the prevalences of surgical site infection and deep surgical site infection after ACLR during hospitalization. The association between the occurrence of surgical site infection and patients' demographic data, including sex, age, body mass index (BMI), smoking status, preoperative steroid use, and comorbidities such as diabetes, hepatic dysfunction, renal dysfunction, and atopic dermatitis, were examined using a multivariable logistic regression model. RESULTS Among 30,536 patients who underwent ACLR, 288 patients with surgical site infection (0.94%) and 86 with deep surgical site infection (0.28%) were identified. The univariate analysis showed that higher prevalences of surgical site infection and deep surgical site infection were associated with male sex, a higher BMI, atopic dermatitis, and preoperative steroid use. Patients with diabetes or hepatic dysfunction had a significantly higher prevalence of surgical site infection. The multivariable analysis showed that surgical site infection was significantly associated with male sex vs. female sex; odds ratio (OR), 2.90; 95% confidence interval (CI), 2.17-3.89, age of ≤ 19 vs. 20-29 years; OR, 1.56; 95% CI 1.13-2.15, BMI of ≥ 30.0 vs. 18.5-22.9 kg/m2; OR, 1.72; 95% CI 1.16-2.54, diabetes (OR, 2.70; 95% CI 1.28-5.71), atopic dermatitis (OR, 7.19; 95% CI 2.94-17.57), and preoperative steroid use (OR, 6.18; 95% CI 2.32-16.52). CONCLUSION Atopic dermatitis, preoperative steroid use, young age (≤ 19 years), obesity (BMI of ≥ 30.0 kg/m2), male sex, and diabetes were independent demographic risk factors for surgical site infection after ACLR. The present study will be useful when surgeons evaluate the risk of SSI after ACLR in terms of demographic aspects. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Manabu Kawata
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yusuke Sasabuchi
- Data Science Center, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kiyohide Fushimi
- Department of Health Informatics and Policy, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Carney J, Heckmann N, Mayer EN, Alluri RK, Jr. CTV, III GFH, Weber AE. Should antibiotics be administered before arthroscopic knee surgery? A systematic review of the literature. World J Orthop 2018; 9:262-270. [PMID: 30479973 PMCID: PMC6242731 DOI: 10.5312/wjo.v9.i11.262] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/12/2018] [Accepted: 10/23/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To explore the current evidence surrounding the administration of prophylactic antibiotics for arthroscopic knee surgery.
METHODS Databases were searched from inception through May of 2018 for studies examining prophylactic antibiotic use and efficacy in knee arthroscopy. Studies with patient data were further assessed for types of arthroscopic procedures performed, number of patients in the study, use of antibiotics, and outcomes with the intention of performing a pooled analysis. Data pertaining to “deep tissue infection” or “septic arthritis” were included in our analysis. Reported data on superficial infection were not included in our data analysis. For the pooled analysis, a relative risk ratio was calculated and χ2 tests were used to assess for statistical significance between rates of infection amongst the various patient groups. Post hoc power analyses were performed to compute the statistical power obtained from our sample sizes. Number needed to treat analyses were performed for statistically significant differences by dividing 1 by the difference between the infection rates of the antibiotic and no antibiotic groups. An alpha value of 0.05 was used for our analysis. Study heterogeneity was assessed by Cochrane’s Q test as well as calculation of the I2 value.
RESULTS A total of 49682 patients who underwent knee arthroscopy for a diverse set of procedures across 19 studies met inclusion critera for pooled analysis. For those not undergoing graft procedures, there were 27 cases of post-operative septic arthritis in 34487 patients (0.08%) who received prophylactic antibiotics and 16 cases in 10911 (0.15%) who received none [risk ratio (RR) = 0.53, 95% confidence interval (CI): 0.29-0.99, P = 0.05]. A sub-group analysis in which bony procedures were excluded was performed which found no significant difference in infection rates between patients that received prophylactic antibiotics and patients that did not (P > 0.05). All anterior cruciate ligament reconstruction studies used prophylactic antibiotics, but two studies investigating the effect of soaking the graft in vancomycin in addition to standard intravenous (IV) prophylaxis were combined for analysis. There were 19 cases in 1095 patients (1.74%) who received IV antibioitics alone and no infections in 2034 patients who received IV antibiotics and had a vancomycin soaked graft (RR = 0.01, 95%CI: 0.001-0.229, P < 0.01).
CONCLUSION Prophylactic antibiotics are effective in preventing septic arthritis following simple knee arthroscopy. In procedures involving graft implantation, graft soaking reduces the rate of infection.
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Affiliation(s)
- John Carney
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA 90033, United States
| | - Nathanael Heckmann
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA 90033, United States
| | - Erik N Mayer
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA 90033, United States
| | - Ram K Alluri
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA 90033, United States
| | | | - George F Hatch III
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA 90033, United States
| | - Alexander E Weber
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA 90033, United States
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Ridley TJ, Rud CT, Krych AJ, Macalena JA. Bacterial Contamination of a Marking Pen in Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2018; 6:2325967118772043. [PMID: 29796399 PMCID: PMC5958422 DOI: 10.1177/2325967118772043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background: A sterile surgical marking pen is commonly used during anterior cruciate ligament reconstruction (ACLR) to outline the proposed skin incision and then to mark the graft during preparation. Once in contact with the skin, the pen is a potential source of bacterial transmission and subsequent infections after ACLR. Purpose/Hypothesis: The purpose of this study was to assess whether the skin marking pen is a fomite for contamination during arthroscopic ACLR. We hypothesized that there would be a difference in the rate of culture-positive pens between control pens and the study pens used to delineate the proposed skin incision. Study Design: Controlled laboratory study. Methods: Twenty surgical marking pens were collected prospectively from patients undergoing ACLR over a 12-month period. All patients underwent standard preoperative sterile preparation and draping procedures. Proposed incisions were marked with a new sterile pen, and the pen tip was immediately sent for a 5-day inoculation in broth and agar. Negative controls (unopened new pen) and positive controls (used to mark the skin incisions preoperatively) were also cultured. Additionally, blank culture dishes were observed during the growth process. All pens were removed from the surgical field before incision, and new marking pens were used when needed during the procedure. Results: Three of the 20 study pens (15%) demonstrated positive growth. All 3 pens grew species of Staphylococcus. None of the negative controls demonstrated growth, 6 of the 12 positive controls showed growth, and none of the blank dishes exhibited growth. Conclusion: This study found a 15% rate of surgical marking pen contamination by Staphylococcus during ACLR. It is recommended that the skin marking pen not be used for any further steps of the surgical case and be discarded once used. Clinical Relevance: Infections after ACLR are rare but may result in significant morbidity, and all measures to reduce them should be pursued. Surgeons performing ACLR should dispose of the surgical marking pen after skin marking and before intraoperative use such as graft markup.
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Affiliation(s)
- Taylor J Ridley
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Christopher T Rud
- College of Osteopathic Medicine, Marian University, Indianapolis, Indiana, USA
| | - Aaron J Krych
- Departments of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey A Macalena
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Abstract
BACKGROUND The Socio-Technical Probabilistic Risk Assessment, a proactive risk assessment tool imported from high-risk industries, was used to identify risks for surgical site infections (SSIs) associated with the ambulatory surgery center setting and to guide improvement efforts. OBJECTIVES This study had 2 primary objectives: (1) to identify the critical risk factors associated with SSIs resulting from procedures performed at ambulatory surgery centers and (2) to design an intervention to mitigate the probability of SSI for the highest risk factors identified. METHODS Inputs included quantitative and qualitative data sources from the evidence-based literature and from health care providers. The Socio-Technical Probabilistic Risk Assessment ranked the failure points (events) on the basis of their contribution to an SSI. The event, entitled "Failure to protect the patient effectively," which included several failure points, was the most critical unique event with the highest contribution to SSI risk. RESULTS A total of 51.87% of SSIs in this setting were caused by this failure. Consequently, we proposed an intervention aimed at all 5 major components of this failure. CONCLUSIONS The intervention targets improvements in skin preparation; proper administration of antibiotics; staff training in infection control principles, including practices for the prevention of glove punctures; and procedures to ensure the removal of watches, jewelry, and artificial nails.
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Kumar M, Thilak J. Infected shoulder joint with loose Suture Anchor in the joint after Bankart's Repair- A Case Report. J Orthop Case Rep 2016; 6:6-8. [PMID: 27703928 PMCID: PMC5040575 DOI: 10.13107/jocr.2250-0685.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: The glenoid labrum is frequently torn in traumatic glenohumeral dislocation; arthroscopic repair is the standard method of treatment. The complications associated with this repair are pulling out of metal suture anchors, chondrolysis and joint infection. The infection of joint after arthroscopy is less than 1%. Staphylococcus is most common organism and rarely followed by Pseudomonas aeruginosa. We report a case of infected shoulder with chondrolysis of the joint and pulled out metal suture anchor lying inside the joint after Bankart’s repair. Case Report: A 22-year-old gentleman came to us with complaints of shoulder joint pain & gross restriction of movements for one year, with history of intermittent fever and treatment in nearby hospital. He also gives past history of recurrent dislocation of shoulder with last episode 18 months back, which was diagnosed as Bankart’s lesion and arthroscopic Bankart’s repair was done 15 months back. He was evaluated at our institute and suspected to have infection of shoulder joint with pulled out metal suture anchor inside the joint. Arthroscopic removal of suture anchor and debridement of shoulder joint was done, Culture was obtained and culture specific antibiotics were given for six weeks, and significant improvement was observed with this line of treatment. At lyear follow up, the patient was able to perform his daily activities with terminal restriction of range of motion. Conclusions: Shoulder joint infection is rare after Bankart’s repair and required a high degree of suspicion. Any foreign materials inside the joint should be taken out & followed with aggressive treatment by debridement, irrigation and culture specific antibiotics. Suppression of joint infection with antibiotics should be avoided specially when there is foreign body inside the joint.
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Affiliation(s)
- Mukesh Kumar
- Department of Orthopedics, AIMS, Kochi, Kerala. India
| | - Jai Thilak
- Department of Orthopedics, AIMS, Kochi, Kerala. India
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14
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Phegan M, Grayson JE, Vertullo CJ. No infections in 1300 anterior cruciate ligament reconstructions with vancomycin pre-soaking of hamstring grafts. Knee Surg Sports Traumatol Arthrosc 2016; 24:2729-2735. [PMID: 25771788 DOI: 10.1007/s00167-015-3558-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/25/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the pre-soaking of hamstring grafts in topical vancomycin, in addition to IV prophylaxis, during anterior cruciate ligament (ACL) reconstruction to reduce the incidence of post-operative infection, and to describe an evidence-based diagnostic and treatment algorithm to facilitate early diagnosis and appropriate management of possible knee sepsis post-operatively after ACL reconstruction. METHODS This study is a controlled observational series comprising of 1585 individuals who underwent ACL reconstruction over a 13-year period. All surgeries were performed by a single surgeon at the same hospital. Group 1 consisted of 285 patients who received pre-operative IV antibiotics without topical graft pre-soaking. Group 2 consisted of 1300 individuals who received IV antibiotics and graft pre-soaking in a vancomycin solution of 5 mg/mL. RESULTS In group 1, a total of four patients suffered a post-operative joint infection (1.4 %). Three out of the four were culture positive for Staphylococcus species. The fourth was culture negative but was managed as an acute infection. Group 2 suffered no post-operative infections (0 %). Statistical analysis of the vancomycin pre-soak with IV antibiotics group, compared with IV antibiotics-alone group, revealed a significantly reduced post-operative infection rate using a Fisher's exact test (P = 0.0011) and Chi-square test with Yates' correction (P = 0.0003). CONCLUSIONS Pre-soaking of hamstrings grafts with topical vancomycin reduced the rate of post-operative infection when compared to IV antibiotics alone. This technique should be utilised by surgeons to reduce the overall incidence of knee sepsis post-ACL reconstruction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Michael Phegan
- Department of Orthopaedics, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Gold Coast, QLD, 4215, Australia.
| | - Jane E Grayson
- Department of Kinesiology and Health Sciences, Stephen F. Austin State University, Nacogdoches, TX, USA
| | - Christopher J Vertullo
- Knee Research Australia, Centre for Musculoskeletal Research, Griffith University, Gold Coast, QLD, Australia
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15
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Staphylococcus lugdunensis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014. [DOI: 10.1097/ipc.0b013e3182a4b48f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Nicoll C, Singh A, Weese JS. Economic Impact of Tibial Plateau Leveling Osteotomy Surgical Site Infection in Dogs. Vet Surg 2014; 43:899-902. [DOI: 10.1111/j.1532-950x.2014.12175.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 01/18/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Catherine Nicoll
- Department of Pathobiology; Ontario Veterinary College, University of Guelph; Guelph ON Canada
| | - Ameet Singh
- Department of Pathobiology and Clinical Studies; Ontario Veterinary College, University of Guelph; Guelph ON Canada
| | - J. Scott Weese
- Department of Pathobiology; Ontario Veterinary College, University of Guelph; Guelph ON Canada
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17
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Abstract
Context: Anterior cruciate ligament (ACL) reconstruction is a safe, common, and effective method of restoring stability to the knee after injury, but evolving techniques of reconstruction carry inherent risk. Infection after ACL reconstruction, while rare, carries a high morbidity, potentially resulting in a poor clinical outcome. Evidence Acquisition: Data were obtained from previously published peer-reviewed literature through a search of the entire PubMed database (up to December 2012) as well as from textbook chapters. Results: Treatment with culture-specific antibiotics and debridement with graft retention is recommended as initial treatment, but with persistent infection, consideration should be given to graft removal. Graft type likely has no effect on infection rates. Conclusion: The early diagnosis of infection and appropriate treatment are necessary to avoid the complications of articular cartilage damage and arthrofibrosis.
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Affiliation(s)
- Charlton Stucken
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - David N Garras
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Julie L Shaner
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Steven B Cohen
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
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18
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Abstract
Management and evaluations of infections after arthroscopy of the knee and shoulder can be difficult and fraught with complications, both medical and legal. This article reviews the literature regarding arthroscopic infections from a historical perspective and discusses the treatment of knee and shoulder infections as well as the complications associated with delayed treatment. It is critical to make the diagnosis as soon as possible subsequent to the initial procedure to avoid postoperative sequelae consisting of stiffness and a decrease in function.
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20
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14:73-156. [PMID: 23461695 DOI: 10.1089/sur.2013.9999] [Citation(s) in RCA: 764] [Impact Index Per Article: 63.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Dale W Bratzler
- College of Public Health, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA.
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21
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195-283. [DOI: 10.2146/ajhp120568] [Citation(s) in RCA: 1364] [Impact Index Per Article: 113.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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22
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Zuckerman SL, Parikh R, Moore DC, Talbot TR. An evaluation of immediate-use steam sterilization practices in adult knee and hip arthroplasty procedures. Am J Infect Control 2012; 40:866-71. [PMID: 22364918 DOI: 10.1016/j.ajic.2011.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 11/09/2011] [Accepted: 11/09/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Immediate-use steam sterilization (IUSS) is a safe method to sterilize emergently contaminated instruments, but inappropriate use may lead to an increased risk for surgical site infection. This study aimed to identify risk factors, rationale, and variability in procedural adherence in cases of IUSS. METHODS This retrospective, case-control study compared adult patients undergoing hip and knee arthroplasty in which IUSS was (n = 104) and was not (n = 81) performed. RESULTS Multivariate analysis revealed 4 predictive risk factors for IUSS: history of malignancy (odds ratio [OR], 3.2 [95% confidence interval (CI) 1.1-9.3]), obesity (OR, 2.3 [95% CI: 1.02-5.2]), procedure performed in operating room 13 (OR, 2.5 [95% CI: 1.2-5.4]), and Monday procedure (OR, 3.6 [95% CI: 1.4-9.1]). The only factor that protected against IUSS was performing the procedure in the morning (OR, 0.4 [95% CI: 0.2-0.96]). Only 9.5% of cases of IUSS involved an acceptable indication. Documented adherence to core practices was also variable. CONCLUSION Several patient- and case-specific factors can help predict the incidence of IUSS. Furthermore, practices should be hardwired to ensure IUSS is utilized for the correct indication. Documentation must be improved to allow institutions to accurately track IUSS.
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23
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Parada SA, Grassbaugh JA, DeVine JG, Arrington ED. Instrumentation-specific infection after anterior cruciate ligament reconstruction. Sports Health 2012; 1:481-5. [PMID: 23015910 PMCID: PMC3445146 DOI: 10.1177/1941738109347975] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Anterior cruciate ligament (ACL) reconstruction is uncommonly complicated by postoperative infections, the causes of which are rarely identified. Hypothesis/Purpose: The goal of this study was to characterize the relationship between methodological sterilization failure and ACL reconstruction infection at an army medical center. Study Design: Case series. Methods: Demographic, clinical, and laboratory data were collected on 5 postoperative infections during a 14-week period in 2003. All ACL reconstructions completed within the past 6 years at the institution were reviewed to establish a baseline infection rate. Results: There was a 14-week period in which 5 cases of infection occurred postoperatively, an infection rate of 12.2%. Previous and subsequent to the identified period, the established rate of infection after ACL reconstruction was 0.3%. There were no violations of sterile technique noted in any of the identified cases. All cases utilized hamstring autograft. All cases also used the DePuy Mitek Intrafix system for tibial fixation of the graft. Two of these cases had positive cultures. Conclusions: An isolated series of increased infection rate led to an investigation into the sterile technique. This revealed gross biomaterial remaining inside instrumentation common to all the cases, the DePuy Mitek Intrafix system. The modular cannulated hex driver, made to fit over a small caliber wire, had no wire brushes of a small-enough diameter for the cleaning and sterilization procedure. After recognition of infection, all patients were treated with surgical irrigation and debridement of the affected knee, as well as individualized antibiotic therapy. Patients were followed postoperatively and no patients required revision ACL reconstruction or radical debridement of the graft.
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Affiliation(s)
- Stephen A. Parada
- Madigan Army Medical Center, Tacoma, Washington
- Address correspondence to Stephen A. Parada, MD, Madigan Army Medical Center, 9040A Fitzsimmons Dr, MAMC Orthopaedics, Tacoma, WA 98431 (e-mail: )
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24
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A surgical technique using presoaked vancomycin hamstring grafts to decrease the risk of infection after anterior cruciate ligament reconstruction. Arthroscopy 2012; 28:337-42. [PMID: 22112612 DOI: 10.1016/j.arthro.2011.08.301] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 08/17/2011] [Accepted: 08/17/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to investigate whether presoaking hamstring graft with a dilute antibiotic solution provides a potential new tool to improve measures to prevent joint infection. METHODS This is a retrospective analysis of data that were prospectively collected for 1,135 consecutive patients who underwent anterior cruciate ligament reconstruction (ACLR) during a 7-year period. In the initial 3-year period, 285 patients (group 1) underwent ACLR with a hamstring autograft with preoperative intravenous (IV) antibiotics. In the subsequent 4-year period, 870 patients underwent ACLR with a vancomycin-presoaked hamstring autograft (group 2) with preoperative IV antibiotics. Presoaking involved wrapping hamstring tendon autografts in a sterile gauze swab, which had been previously saturated with 5-mg/mL vancomycin solution. RESULTS In group 1 a total of 4 postoperative joint infections were documented (1.4%). Each case showed increasing pain and effusion, as well as a high intra-articular white blood cell count and increased C-reactive protein level. Of the 4 infected cases, 3 cultured coagulase-negative Staphylococcus (Staphylococcus epidermidis). The fourth case was treated as a postoperative infection despite a negative culture and responded to arthroscopic washout and IV antibiotics. In group 2 no infections (0%) were recorded, and no investigatory washouts occurred. The difference was statistically significant. Known failures were similar in each group. CONCLUSIONS Prophylactic vancomycin presoaking of hamstring autografts statistically reduced the infection rate in this series compared with IV antibiotics alone. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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25
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Tosh PK, Disbot M, Duffy JM, Boom ML, Heseltine G, Srinivasan A, Gould CV, Berríos-Torres SI. Outbreak of Pseudomonas aeruginosa surgical site infections after arthroscopic procedures: Texas, 2009. Infect Control Hosp Epidemiol 2011; 32:1179-86. [PMID: 22080656 DOI: 10.1086/662712] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
SETTING Seven organ/space surgical site infections (SSIs) that occurred after arthroscopic procedures and were due to Pseudomonas aeruginosa of indistinguishable pulsed-field gel electrophoresis (PFGE) patterns occurred at hospital X in Texas from April 22, 2009, through May 7, 2009. OBJECTIVE To determine the source of the outbreak and prevent future infections. DESIGN Infection control observations and a case-control study. METHODS Laboratory records were reviewed for case finding. A case-control study was conducted. A case patient was defined as someone who underwent knee or shoulder arthroscopy at hospital X during the outbreak period and subsequently developed organ/space SSI due to P. aeruginosa. Cultures of environmental and surgical equipment samples were performed, and selected isolates were analyzed by PFGE. Surgical instrument reprocessing practices were reviewed, and surgical instrument lumens were inspected with a borescope after reprocessing to assess cleanliness. RESULTS The case-control study did not identify any significant patient-related or operator-related risk factors. P. aeruginosa grew from 62 of 388 environmental samples. An isolate from the gross decontamination sink had a PFGE pattern that was indistinguishable from that of the case patient isolates. All surgical instrument cultures showed no growth. Endoscopic evaluation of reprocessed arthroscopic equipment revealed retained tissue in the lumen of both the inflow/outflow cannulae and arthroscopic shaver handpiece. No additional cases occurred after changes in instrument reprocessing protocols were implemented. After this outbreak, the US Food and Drug Administration released a safety alert about the concern regarding retained tissue within arthroscopic shavers. CONCLUSIONS These SSIs were likely related to surgical instrument contamination with P. aeruginosa during instrument reprocessing. Retained tissue in inflow/outflow cannulae and shaver handpieces could have allowed bacteria to survive sterilization procedures.
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Affiliation(s)
- Pritish K Tosh
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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26
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Ridge PA. A retrospective study of the rate of postoperative septic arthritis following 353 elective arthroscopies. J Small Anim Pract 2011; 52:200-2. [DOI: 10.1111/j.1748-5827.2011.01050.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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27
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Acklin YP, Widmer AF, Renner RM, Frei R, Gross T. Unexpectedly increased rate of surgical site infections following implant surgery for hip fractures: problem solution with the bundle approach. Injury 2011; 42:209-16. [PMID: 21047637 DOI: 10.1016/j.injury.2010.09.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 08/26/2010] [Accepted: 09/30/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical site infections (SSIs) are the most common nosocomial infections after surgery.However, clinical guidance on how to handle any suspicious clusters of SSI in orthopaedic surgery is missing. We report on problem analysis and solution finding following the observation of an increased rate of SSI in trauma implant surgery. SETTING Trauma unit of a university hospital. METHODS Over a 2-year observation period, all patients (n = 370) following surgical stabilisation of proximal femur fractures in a trauma unit of a university hospital were consecutively followed using a standardised case report form. First, a retrospective cohort of 217 patients was collected for whom an increased SSI rate was detected. Based on risk analysis, new standard perioperative procedures were developed and implemented. The impact was evaluated in a prospective cohort of 153 comparable patients. Uni- and multivariable analysis of factors associated with the risk for SSI was undertaken. RESULTS The intervention bundle resulted in a significant reduction of an initially increased SSI incidence of 6.9 (down) to 2.0% (p = 0.029). Multivariable analysis revealed four risk factors significantly associated with a higher risk of SSI caused by different bacteria: duration of surgery (p = 0.002), hemiarthroplasty(p = 0.002), haematoma (p = 0.004) and the presence of two operating room staff members (p < 0.001 and 0.035). CONCLUSIONS A standardised prospective SSI protocol and detection system offering the simultaneous use of data should guarantee every institution immediate alarm registration to avoid comparable problem situations. Detailed interdisciplinary analysis followed by the implementation of coherent interventions, based on a best-evidence structured bundle approach, may adequately resolve similar critical incidence episodes.
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Affiliation(s)
- Yves P Acklin
- Department of Surgery, Kantonsspital Graubünden, Loëstrasse 170, CH-7000 Chur, Switzerland
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28
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Uçkay I, Harbarth S, Peter R, Lew D, Hoffmeyer P, Pittet D. Preventing surgical site infections. Expert Rev Anti Infect Ther 2010; 8:657-70. [PMID: 20521894 DOI: 10.1586/eri.10.41] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The risk of surgical site infection (SSI) is approximately 1-3% for elective clean surgery. Apart from patient endogenous factors, the role of external risk factors in the pathogenesis of SSI is well recognized. However, among the many measures to prevent SSI, only some are based on strong evidence, for example, adequate perioperative administration of prophylactic antibiotics, and there is insufficient evidence to show whether one method is superior to any other. This highlights the need for a multimodal approach involving active post-discharge surveillance, as well as measures at every step of the care process, ranging from the operating theater to postoperative care. Multicenter or supranational intervention programs based on evidence-based guidelines, 'bundles' or safety checklists are likely to be beneficial on a global scale. Although theoretically reducible to zero, the maximal realistic extent by which SSI can be decreased remains unknown.
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Affiliation(s)
- Ilker Uçkay
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
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Stone PW, Kunches L, Hirschhorn L. Cost of hospital-associated infections in Massachusetts. Am J Infect Control 2009; 37:210-4. [PMID: 19111366 DOI: 10.1016/j.ajic.2008.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Accepted: 07/29/2008] [Indexed: 11/19/2022]
Abstract
The Massachusetts Department of Public Health appointed an Expert Panel to assess the problem of health care-associated infections (HAI) in the state and make recommendations regarding mandatory reporting. At the Expert Panel's request, a cost-of-illness study was conducted using available data sources. In Massachusetts, the excess hospital costs attributed to HAIs were estimated at approximately $233 to $275 million in 2006.
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Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: a retrospective analysis of incidence, presentation, treatment, and cause. Arthroscopy 2009; 25:243-9. [PMID: 19245985 DOI: 10.1016/j.arthro.2008.10.002] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2008] [Revised: 09/22/2008] [Accepted: 10/10/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this report is to summarize our experience in the diagnosis and management of septic arthritis after anterior cruciate ligament (ACL) reconstruction. METHODS A retrospective review was conducted of all the arthroscopic ACL reconstructions performed at our institution between 1997 and 2007. Postoperative septic arthritis occurred in 21 of 4,068 patients. The incidence, cause, presentation, laboratory results, and treatment of all infected patients were analyzed. RESULTS The incidence of septic arthritis after ACL reconstruction was 0.52%. The most common symptoms of the infected patients were fever, swelling, severe pain, tenderness, and restricted motion. The erythrocyte sedimentation rate, C-reactive protein level, and fibrinogen level were markedly elevated. Microbiology showed that coagulase-negative Staphylococcus was the most common bacterium. Both conservative and operative treatments were effective, and no patient had the ACL graft removed. However, the conservative group had a longer recovery time and duration of intravenous antibiotic therapy. CONCLUSIONS Septic arthritis after arthroscopic ACL reconstruction is a rare but potentially devastating complication. The correct diagnosis relies on clinical evaluation, laboratory tests, synovial fluid analysis, and bacterial culture. With early diagnosis and prompt treatment, the infection can be successfully eradicated. Our proposed treatment protocol is arthroscopic debridement and irrigation as quickly as possible, with retention of the ACL graft when it is still functional. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Kobayashi M, Nakagawa Y, Okamoto Y, Nakamura S, Nakamura T. Structural damage and chemical contaminants on reprocessed arthroscopic shaver blades. Am J Sports Med 2009; 37:266-73. [PMID: 19118081 DOI: 10.1177/0363546508325668] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In response to socioeconomic pressure to cut budgets in medicine, single-use surgical instruments are often reprocessed despite potential biological hazard. PURPOSE To evaluate the quality and contaminants of reprocessed shaver blades. HYPOTHESIS Reprocessed shaver blades have mechanical damage and chemical contamination. STUDY DESIGN Controlled laboratory study. METHODS Seven blades and 3 abraders were reprocessed 1 time or 3 times and then were assessed. In the first part of the study, structural damage on the blades after 3 reprocessings was compared to that after 1 reprocessing using optical microscopy. In the second part, surface damage was observed using optical microscopy and scanning electron microscopy; elemental and chemical analyses of contaminants found by the microscopy were performed using scanning electron microscopy/energy dispersive x-ray spectroscopy, scanning Auger microscopy, and Fourier transform infrared spectroscopy. RESULTS Optical microscopic examination revealed abrasion on the surface of the inner blade and cracks on the inner tube after 1 reprocessing. These changes were more evident after 3 reprocessings. Scanning electron microscopy/energy dispersive x-ray spectroscopy of the inner cutter of the blade reprocessed once showed contaminants containing calcium, carbon, oxygen, and silicon, and Fourier transform infrared spectroscopy demonstrated biological protein consisting mainly of collagen, some type of salts, and polycarbonate used in plastic molding. Scanning electron microscopy/energy dispersive x-ray spectroscopy of the inner cutter of the reprocessed abrader revealed contaminants containing carbon, calcium, phosphorous, and oxygen, and Fourier transform infrared spectroscopy showed H2O, hydroxyapatite, and hydroxyl proteins. Scanning Auger microscopy showed that the tin-nickel plating on the moving blade and abrader was missing in some locations. CONCLUSION This is the first study to evaluate both mechanical damage and chemical contaminants containing collagen, hydroxyapatite, and salts on the reprocessed arthroscopic shaver blades. CLINICAL RELEVANCE Surgeons should keep in mind that mechanical damage and chemical contamination are found on reprocessed arthroscopic blades.
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Affiliation(s)
- Masahiko Kobayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
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Lin F, Lawley M, Spry C, McCarthy K, Coyle-Rogers PG, Yih Y. Using Simulation to Design a Central Sterilization Department. AORN J 2008; 88:555-67. [DOI: 10.1016/j.aorn.2008.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Revised: 02/13/2008] [Accepted: 03/13/2008] [Indexed: 11/27/2022]
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Saadatian-Elahi M, Teyssou R, Vanhems P. Staphylococcus aureus, the major pathogen in orthopaedic and cardiac surgical site infections: a literature review. Int J Surg 2007; 6:238-45. [PMID: 17561463 DOI: 10.1016/j.ijsu.2007.05.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Revised: 05/01/2007] [Accepted: 05/01/2007] [Indexed: 01/28/2023]
Abstract
Due to the increasing number of orthopaedic and cardiac procedures, these units are considered as high-risk areas because of the potentially serious consequences of surgical site infections (SSI), primarily caused by Staphylococcus aureus. The goal of this review was to evaluate the impact of S. aureus on the incidence of SSI in these high risk wards. Studies were identified by a search on the MEDLINE literature using the following mesh terms: S. aureus, cardiac, orthopaedic, surgery, SSI. Beside, data from different surveillance systems were also included. Overall, biological investigation was performed only on a small proportion of identified SSIs. Of those identified, S. aureus represented the most common pathogen accounting for approximately 20% of all SSIs. Of the 59,274 hip prostheses reported from the HELICS surveillance network, S. aureus formed 48.6% of the pathogens (416 bacteria isolated). Similarly, it represented 43.7% of pathogens after coronary artery bypass grafting. Although S. aureus turned out to be the major pathogen, this work identifies the relative lack of knowledge on the overall incidence of S. aureus infections and on the impact of this pathogenic agent when taking into consideration the degree of wound contamination and category of SSI. There is a need for more detailed information on the role of S. aureus in the burden of surgical site infections and consequently how to establish multiple approach prevention programs.
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Affiliation(s)
- Mitra Saadatian-Elahi
- Laboratoire d'Epidémiologie et de Santé Publique, INSERM 271, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69373 Lyon Cedex 08, France.
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Bert JM, Giannini D, Nace L. Antibiotic prophylaxis for arthroscopy of the knee: is it necessary? Arthroscopy 2007; 23:4-6. [PMID: 17210420 DOI: 10.1016/j.arthro.2006.08.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Revised: 08/08/2006] [Accepted: 08/14/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE Our purpose was to determine the incidence of infection after routine arthroscopic meniscectomy of the knee with and without preoperative prophylactic intravenous antibiotics. METHODS A retrospective review of 3,231 arthroscopic knee surgeries was performed at a physician-owned in-office ambulatory surgery center over a 3-year period, of which 2,780 were arthroscopic meniscectomies. The cases were evaluated with respect to the incidence of deep infection as evidenced by a positive joint aspirate. Approximately 30% of the patients had prophylactic intravenous antibiotics within 1 hour before the arthroscopic procedure. RESULTS The infection rate was 0.15% in those patients who received antibiotics and 0.16% in those who did not receive antibiotics (P = .59). CONCLUSIONS The results of this study confirm that there is no value in administering antibiotics before routine arthroscopic meniscectomy to prevent joint sepsis. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Jack M Bert
- Summit Orthopedics, Ltd., St. Paul, Minnesota 55102, USA
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Seoane-Vazquez E, Rodriguez-Monguio R, Visaria J, Carlson A. Exogenous endoscopy-related infections, pseudo-infections, and toxic reactions: clinical and economic burden. Curr Med Res Opin 2006; 22:2007-21. [PMID: 17022860 DOI: 10.1185/030079906x121048] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The objective of this study was to analyze the characteristics and costs of exogenous endoscopy-related infections, pseudo-infections, and toxic reactions in the US. METHODS A systematic review of the scientific literature published between 1966 and 2005 was conducted in Medline. Data collection was based on a prospective protocol developed by the authors. RESULTS The literature review included 70 outbreaks described in 64 scientific articles. Bronchoscopy accounted for half of all reported outbreaks. Inadequate decontamination practices were the leading cause of contamination; equipment malfunction became the second leading cause of contamination during the period 1990-2004. More than 91% of the infections identified could be prevented by health care providers if quality control systems are improved and implemented. The available economic information concerning exogenous endoscope related events is very limited. A model for the analysis of the economic burden of exogenous endoscopy-related events is proposed. CONCLUSIONS Proper decontamination practices, the use of protective sheaths, and the improvement of surveillance systems could reduce the clinical and economic burdens associated with exogenous endoscopy-related events.
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Kurzweil PR. Antibiotic prophylaxis for arthroscopic surgery. Arthroscopy 2006; 22:452-4. [PMID: 16581459 DOI: 10.1016/j.arthro.2006.02.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2006] [Revised: 02/22/2006] [Accepted: 02/22/2006] [Indexed: 02/02/2023]
Abstract
Because the incidence of infection in arthroscopic surgery is very low, one can argue both for and against the use of prophylactic antibiotics. Administering antibiotics adds expense and introduces the potential for both exposure to allergic reactions and selection of resistant organisms. Antibiotics are given to prevent deep infection; such treatment may require further surgery, prolonged use of intravenous antibiotics, high costs, and outcomes that may be less than satisfactory. An answer to this controversial issue would require a study that includes large numbers of patients to make it adequately statistically powered because the incidence of infection is so low. No such research has yet been performed, and the American Academy of Orthopaedic Surgeons (AAOS) has not produced an advisory statement addressing this issue. It is the opinion of this author that antibiotic prophylaxis is indicated for arthroscopic surgery. Despite surgical team best practices, mistakes can occur. This has led the AAOS to issue an advisory statement to prevent wrong-site surgery. Similarly, complacency with repetition may produce breaks in sterility that may occasionally go undetected. Antibiotic usage may help to reduce infection in such circumstances. Arthroscopic procedures are not always performed in healthy patients. The risk of infection in "high-risk" patients, such as those with diabetes, immune problems, and skin disorders, may be reduced by prophylactic antibiotics. How one defines a case as arthroscopic can be debated. If small incisions are made, or if the scope is used for only a portion of the procedure, many would still consider the case to be arthroscopic. Surgeries are becoming more complex, which adds to their duration. Some cases also involve the use of implants such as interference screws and suture anchors. It is my opinion that antibiotics should be used in these situations. The potential exists for litigation in cases of infection. Medicolegally, it is easier to argue that all measures were taken to prevent infection if prophylactic antibiotics were given, although patient care issues supersede defensive medicine. Risk of infection in arthroscopic surgery is multifactorial, and antibiotic prophylaxis is only one facet of the issue. Although it is my opinion that antibiotics are recommended, others could be justified in supporting the opposite opinion, pending appropriately designed and adequately powered future investigations.
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Affiliation(s)
- Peter R Kurzweil
- Southern California Center for Sports Medicine, Long Beach, California, USA.
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Werner CML, Necas T, Schneeberger AG. Defects of camera covers after arthroscopic surgery. J Shoulder Elbow Surg 2006; 15:199-202. [PMID: 16517365 DOI: 10.1016/j.jse.2005.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Accepted: 08/16/2005] [Indexed: 02/01/2023]
Abstract
Arthroscopic cameras are used either sterilized or in an unsterile manner enveloped in a sterile cover. The goal of this investigation was to determine the integrity of camera covers after arthroscopic procedures, as defects of camera covers have been occasionally observed by us. Such defects might be a potential cause of infection. Six different types of camera covers were tested in a prospective randomized study involving 90 consecutive shoulder arthroscopies. After surgery, the covers were tested by filling them with water up to a level of 20 cm. Any water leaks were recorded. Of all tested camera covers, 74% had 1 to 9 holes involving all types of covers. Of the holes, 17% were larger than 1 mm. In addition, 37% of the covers leaked at the junction between the cover and the arthroscope. The type of cover with the lowest number of leaks had the largest diameter of all tested covers and included an arthroscope adapter, in contrast to the others, which were only sealed off from the arthroscope by adhesive tape. One cover with tape sealing leaked more frequently than the others at the junction (93% of cases, P < .003). The tested camera covers are fragile and tend to leak. This might be a potential risk factor for infection. Mechanically more resistant camera covers or sterilized cameras without the need for covers should be used instead.
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Affiliation(s)
- C M L Werner
- Department of Orthopaedic Surgery, University of Zurich, Balgrist, Switzerland
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Stone PW, Braccia D, Larson E. Systematic review of economic analyses of health care-associated infections. Am J Infect Control 2005; 33:501-9. [PMID: 16260325 DOI: 10.1016/j.ajic.2005.04.246] [Citation(s) in RCA: 220] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Revised: 04/04/2005] [Accepted: 04/05/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Economic evidence is needed to assess the burden of health care-associated infections (HAIs) and cost-effectiveness of interventions aimed at reducing related morbidity and mortality. The objective of this study was conducted to assess the quality of economic evaluations related to HAI and synthesize the evidence. METHODS A systematic review of research published between January 2001 and June 2004 was conducted. Quality of the publication was estimated using a Likert-type scale. All cost estimates were standardized into a common currency. Descriptive statistics and a logistic regression were conducted to identify predictors of high quality. RESULTS 70 studies were audited. There was wide variation in these cost estimates. Publications estimating the cost attributable to an infection were almost 7 times more likely judged to be of higher quality than studies of the cost of interventions (P < .05). Papers in which the authors stated the perspective (hospital or societal) were twice as likely to be judged as being of high quality (P < .05). CONCLUSION There are more publications and growing interest in estimating the costs of HAI. However, the methods employed vary. We recommend (1) the use of guidelines for authors and editors on conducting an economic analysis, (2) development of more sophisticated mathematical models, and (3) training of infection control professionals in economic methods.
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