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Impact of an Infection Control and Antimicrobial Stewardship Program on Solid Organ Transplantation and Hepatobiliary Surgical Site Infections

Published online by Cambridge University Press:  03 October 2016

Charles Frenette ,
David Sperlea ,
Yveta Leharova  and
Daniel J. G. Thirion
Charles Frenette
Affiliation:
Infectious Diseases Department, McGill University Health Center (MUHC), Montreal, Quebec, Canada
David Sperlea
Affiliation:
Faculté de pharmacie, Université de Montréal, Montreal, Quebec, Canada
Yveta Leharova
Affiliation:
Infection Prevention and Control Department, Royal Victoria Hospital, McGill University Health Center (MUHC), Montreal, Quebec, Canada
Daniel J. G. Thirion*
Affiliation:
Pharmacy Department, McGill University Health Center (MUHC) and Faculté de pharmacie, Université de Montréal, Montreal, Quebec, Canada
*
Address correspondence to Daniel J.G. Thirion, PharmD, FCSHP, Faculté de pharmacie, Université de Montréal, PO Box 6128, succ. Centre-ville, Montreal, Quebec, Canada H3C 3J7 (Daniel.thirion@umontreal.ca).
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Abstract

OBJECTIVE

The goal of this long-term quasi-experimental retrospective study was to assess the impact of a 5-year serial infection control and antimicrobial stewardship intervention on surgical site infections (SSIs).

METHODS

This study was conducted in a tertiary-care public teaching institution over a 5-year period from January 2010 to December 2014. All patients undergoing hepatobiliary surgery and liver, kidney, pancreas, and simultaneous pancreas–kidney transplantation were included. Outcomes were compared between a preintervention group (2010–2011) and a postintervention group (2012–2014).

RESULTS

A total of 1,424 procedures averaged an overall SSI rate of 11.2%. After implementation of the interventions, a decrease of 52.8% in SSI rates from 17.4% to 8.2% was observed (P<.001; odds ratio [OR], 2.1; 95% confidence interval [CI], 1.5–2.9). An overall significant decrease >50% (relative rate; P<.001) was observed in superficial incisional and organ-space infections between pre- and postintervention groups. In addition, a 54.9% decrease from 19.7% to 8.9% (P<.001; OR, 2.2; 95% CI, 1.4–3.5) and a 51.6% decrease from 15.5% to 7.5% (P=.001; OR, 2.2; 95% CI, 1.4–3.5) were observed for SSI rates in hepatobiliary surgery and solid organ transplantation, respectively. The antimicrobial stewardship intervention increased overall conformity to the internal surgical prophylaxis protocol by 15.2% (absolute rate) from 45.1% to 60.3% (P<.003; 95% CI, 5.4–24.9).

CONCLUSIONS

A long-term serial infection control and antimicrobial stewardship intervention decreased SSIs among patients undergoing hepatobiliary surgery and liver, kidney, pancreas, and simultaneous pancreas–kidney transplantation.

Infect Control Hosp Epidemiol 2016;1468–1474

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 12 , December 2016 , pp. 1468 - 1474
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Klevens, RM, Edwards, JR, Richards, CL Jr, et al. Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep 2007;122:160–166.Google Scholar
2. Zimlichman, E, Henderson, D, Tamir, O, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med 2013;173:2039–2046.CrossRefGoogle ScholarPubMed
3. Broex, EC, van Asselt, AD, Bruggeman, CA, van Tiel, FH. Surgical site infections: how high are the costs? J Hosp Infect 2009;72:193–201.Google Scholar
4. Shepard, J, Ward, W, Milstone, A, et al. Financial impact of surgical site infections on hospitals: the hospital management perspective. JAMA Surg 2013;148:907–914.CrossRefGoogle ScholarPubMed
5. CDC NNIS System. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.CrossRefGoogle Scholar
6. Edwards, JR, Peterson, KD, Mu, Y, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37:783–805.Google Scholar
7. Hollenbeak, CS, Alfrey, EJ, Souba, WW. The effect of surgical site infections on outcomes and resource utilization after liver transplantation. Surgery 2001;130:388–395.Google Scholar
8. Smets, YF, van der Pijl, JW, van Dissel, JT, Ringers, J, de Fijter, JW, Lemkes, HH. Infectious disease complications of simultaneous pancreas kidney transplantation. Nephrol Dial Transplant 1997;12:764–771.Google Scholar
9. Perdiz, LB, Furtado, GH, Linhares, MM, Gonzalez, AM, Pestana, JO, Medeiros, EA. Incidence and risk factors for surgical site infection after simultaneous pancreas-kidney transplantation. J Hosp Infect 2009;72:326–331.Google Scholar
10. Reddy, KS, Stratta, RJ, Shokouh-Amiri, MH, Alloway, R, Egidi, MF, Gaber, AO. Surgical complications after pancreas transplantation with portal-enteric drainage. J Am Coll Surg 1999;189:305–313.CrossRefGoogle ScholarPubMed
11. Menezes, FG, Wey, SB, Peres, CA, Medina-Pestana, JO, Camargo, LF. What is the impact of surgical site infection on graft function in kidney transplant recipients? Transplant Infect Dis 2010;12:392–396.CrossRefGoogle ScholarPubMed
12. Lynch, RJ, Ranney, DN, Shijie, C, Lee, DS, Samala, N, Englesbe, MJ. Obesity, surgical site infection, and outcome following renal transplantation. Ann Surg 2009;250:1014–1020.CrossRefGoogle ScholarPubMed
13. Bratzler, DW, Dellinger, EP, Olsen, KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013;70:195–283.CrossRefGoogle ScholarPubMed
14. Ceppa, EP, Pitt, HA, House, MG, et al. Reducing surgical site infections in hepatopancreatobiliary surgery. HPB (Oxford) 2013;15:384–391.CrossRefGoogle ScholarPubMed
15. Frenette, C, Sperlea, D, Tesolin, J, Patterson, C, Thirion, DJG. Influence of a 5-year serial infection control and antibiotic stewardship intervention on cardiac surgical site infections. Am J Infect Control 2016;44:977–982.Google Scholar
16. Surgical site infection (SSI) event. Centers for Disease Prevention and Control website. http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf. Updated April 2015. Accessed June 2015.Google Scholar
17. Choudhary, A, Bechtold, ML, Puli, SR, Othman, MO, Roy, PK. Role of prophylactic antibiotics in laparoscopic cholecystectomy: a meta-analysis. J Gastrointest Surg 2008;12:1847–1853; discussion 1853.Google Scholar
18. Hirokawa, F, Hayashi, M, Miyamoto, Y, et al. Evaluation of postoperative antibiotic prophylaxis after liver resection: a randomized controlled trial. Am J Surg 2013;206:8–15.Google Scholar
19. Ren, J, Bao, L, Niu, J, Wang, Y, Ren, X. Prophylactic antibiotics used in patients of hepatobiliary surgery. Pak J Med Sci 2013;29:1199–1202.Google Scholar
20. Asensio, A, Ramos, A, Cuervas-Mons, V, et al. Effect of antibiotic prophylaxis on the risk of surgical site infection in orthotopic liver transplant. Liver Transpl 2008;14:799–805.Google Scholar
21. Novick, AC. The value of intraoperative antibiotics in preventing renal transplant wound infections. J Urol 1981;125:151–152.Google Scholar
22. Everett, JE, Wahoff, DC, Statz, C, et al. Characterization and impact of wound infection after pancreas transplantation. Arch Surg 1994;129:1310–1317.CrossRefGoogle ScholarPubMed
23. Dantas, SR, Kuboyama, RH, Mazzali, M, Moretti, ML. Nosocomial infections in renal transplant patients: risk factors and treatment implications associated with urinary tract and surgical site infections. J Hosp Infect 2006;63:117–123.Google Scholar
24. Ramos, A, Asensio, A, Munez, E, et al. Incisional surgical site infection in kidney transplantation. Urology 2008;72:119–123.CrossRefGoogle ScholarPubMed
25. Humar, A, Ramcharan, T, Denny, R, Gillingham, KJ, Payne, WD, Matas, AJ. Are wound complications after a kidney transplant more common with modern immunosuppression? Transplantation 2001;72:1920–1923.Google Scholar
26. Yansouni, CP, Dendukuri, N, Liu, G, et al. Positive cultures of organ preservation fluid predict postoperative infections in solid organ transplantation recipients. Infect Control Hosp Epidemiol 2012;33:672–680.Google Scholar
27. Webster, J, Osborne, S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev 2015;2:CD004985.Google Scholar
28. Kapadia, BH, Johnson, AJ, Daley, JA, Issa, K, Mont, MA. Pre-admission cutaneous chlorhexidine preparation reduces surgical site infections in total hip arthroplasty. J Arthroplasty 2013;28:490–493.Google Scholar
29. Edmiston, CE Jr, Krepel, CJ, Seabrook, GR, Lewis, BD, Brown, KR, Towne, JB. Preoperative shower revisited: can high topical antiseptic levels be achieved on the skin surface before surgical admission? J Am Coll Surg 2008;207:233–239.CrossRefGoogle ScholarPubMed
30. Dubrovskaya, Y, Tejada, R, Bosco, J 3rd, et al. Single high dose gentamicin for perioperative prophylaxis in orthopedic surgery: evaluation of nephrotoxicity. SAGE Open Med 2015;3:2050312115612803.Google Scholar
31. Nielsen, DV, Fedosova, M, Hjortdal, V, Jakobsen, CJ. Is single-dose prophylactic gentamicin associated with acute kidney injury in patients undergoing cardiac surgery? A matched-pair analysis. J Thorac Cardiovasc Surg 2014;148:1634–1639.Google Scholar