Top

Published in:

01-02-2014

Pressurized Pulse Irrigation with Saline Reduces Surgical-site Infections following Major Hepatobiliary and Pancreatic Surgery: Randomized Controlled Trial

Authors: Mehrdad Nikfarjam, Laurence Weinberg, Michael A. Fink, Vijayaragavan Muralidharan, Graham Starkey, Robert Jones, Kevin Staveley-O’Carroll, Christopher Christophi

Published in: World Journal of Surgery | Issue 2/2014

Abstract

Background

Surgical site infections (SSI) are a significant cause of postoperative morbidity. Pressurized pulse irrigation of subcutaneous tissues may lower infection rates by aiding in the debridement of necrotic tissue and reducing bacterial counts compared to simply pouring saline into the wound.

Methods

A total of 128 patients undergoing laparotomy extending beyond 2 h were randomized to treatment of wounds by pressurized pulse lavage irrigation (<15 psi) with 2 L normal saline (pulse irrigation group), or to standard irrigation with 2 L normal saline poured into the wound, immediately prior to skin closure (standard group). Only elective cases were included, and all cases were performed within a specialized hepatobiliary and pancreatic surgery unit.

Results

There were 62 patients managed by standard irrigation and 68 were managed by pulse irrigation. The groups were comparable in most aspects. Overall there were 16 (13 %) SSI. Significantly fewer SSI occurred in the pulse irrigation group [4 (6 %) vs. 12 (19 %); p = 0.032]. On multivariate analysis, the use of pulse irrigation was the only factor associated with a reduction in SSI with an odds ratio (OR) of 0.3 [95 % confidence interval (95 % CI) 0.1–0.8; p = 0.031]. In contrast, hospital length of stay of greater than 14 days was associated with increased infections with an OR of 7.6 (95 % CI 2.4–24.9; p = 0.001).

Conclusions

Pulse irrigation of laparotomy wounds in operations exceeding 2 h duration reduced SSI after major hepatobiliary pancreatic surgery. (Australian New Zealand Clinical Trials Registry, ACTRN12612000170820).

Hollenbeak CS, Murphy DM, Koenig S et al (2000) The clinical and economic impact of deep chest surgical site infections following coronary artery bypass graft surgery. Chest 118:397–402PubMedCrossRef

Whitehouse JD, Friedman ND, Kirkland KB et al (2002) The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol 23:183–189PubMedCrossRef

Gaynes RP, Culver DH, Horan TC et al (2001) Surgical site infection (SSI) rates in the United States, 1992–1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis 33(Suppl 2):S69–S77PubMedCrossRef

Murray BW, Huerta S, Dineen S et al (2010) Surgical site infection in colorectal surgery: a review of the nonpharmacologic tools of prevention. J Am Coll Surg 211:812–822PubMedCrossRef

Mangram AJ, Horan TC, Pearson ML et al (1999) Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20:250–278 quiz 279–280PubMedCrossRef

Fujita S, Saito N, Yamada T et al (2007) Randomized, multicenter trial of antibiotic prophylaxis in elective colorectal surgery: single dose vs 3 doses of a second-generation cephalosporin without metronidazole and oral antibiotics. Arch Surg 142:657–661PubMedCrossRef

Darouiche RO, Wall MJ Jr, Itani KM et al (2010) Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 362:18–26PubMedCrossRef

Itani KM, Wilson SE, Awad SS et al (2006) Ertapenem versus cefotetan prophylaxis in elective colorectal surgery. N Engl J Med 355:2640–2651PubMedCrossRef

Arnaud JP, Bellissant E, Boissel P et al (1992) Single-dose amoxycillin-clavulanic acid vs. cefotetan for prophylaxis in elective colorectal surgery: a multicentre, prospective, randomized study. The PRODIGE Group. J Hosp Infect 22(Suppl A):23–32PubMedCrossRef

10.

Fournel I, Tiv M, Soulias M et al (2010) Meta-analysis of intraoperative povidone-iodine application to prevent surgical-site infection. Br J Surg 97:1603–1613PubMedCrossRef

11.

Cheng KP, Roslani AC, Sehha N et al (2012) ALEXIS O-Ring wound retractor vs conventional wound protection for the prevention of surgical site infections in colorectal resections(1). Colorectal Dis 14:e346–e351PubMedCrossRef

12.

Reid K, Pockney P, Draganic B et al (2010) Barrier wound protection decreases surgical site infection in open elective colorectal surgery: a randomized clinical trial. Dis Colon Rectum 53:1374–1380PubMedCrossRef

13.

Hughes MS, Moghadamian ES, Yin LY et al (2012) Comparison of bulb syringe, pressurized pulsatile, and hydrosurgery debridement methods for removing bacteria from fracture implants. Orthopedics 35:e1046–e1050PubMedCrossRef

14.

Chikawa T, Sakai T, Bhatia NN et al (2011) Retrospective study of deep surgical site infections following spinal surgery and the effectiveness of continuous irrigation. Br J Neurosurg 25:621–624PubMedCrossRef

15.

Hargrove R, Ridgeway S, Russell R et al (2006) Does pulse lavage reduce hip hemiarthroplasty infection rates? J Hosp Infect 62:446–449PubMedCrossRef

16.

Watanabe M, Sakai D, Matsuyama D et al (2010) Risk factors for surgical site infection following spine surgery: efficacy of intraoperative saline irrigation. J Neurosurg Spine 12:540–546PubMedCrossRef

17.

Luedtke-Hoffmann KA, Schafer DS (2000) Pulsed lavage in wound cleansing. Phys Ther 80:292–300PubMed

18.

Nikfarjam M, Kimchi ET, Gusani NJ et al (2009) Reduction of surgical site infections by use of pulsatile lavage irrigation after prolonged intra-abdominal surgical procedures. Am J Surg 198:381–386PubMedCrossRef

19.

Jarvis WR (2003) Benchmarking for prevention: the Centers for Disease Control and Prevention’s National Nosocomial Infections Surveillance (NNIS) system experience. Infection 31(Suppl 2):44–48PubMed

20.

Dominioni L, Imperatori A, Rotolo N et al (2006) Risk factors for surgical infections. Surg Infect (Larchmt) 7(Suppl 2):S9–S12

21.

Horan TC, Culver DH, Gaynes RP et al (1993) Nosocomial infections in surgical patients in the United States, January 1986–June 1992. National Nosocomial Infections Surveillance (NNIS) System. Infect Control Hosp Epidemiol 14:73–80PubMedCrossRef

22.

Bratzler DW (2006) The Surgical Infection Prevention and Surgical Care Improvement Projects: promises and pitfalls. Am Surg 72:1010–1016 (discussion 1021–1030, 1133–1048)PubMed

23.

Tanner J, Moncaster K, Woodings D (2007) Preoperative hair removal: a systematic review. J Perioper Pract 17(118–121):124–132

24.

Ata A, Lee J, Bestle SL et al (2010) Postoperative hyperglycemia and surgical site infection in general surgery patients. Arch Surg 145:858–864PubMedCrossRef

25.

Meyhoff CS, Wetterslev J, Jorgensen LN et al (2009) Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial. JAMA 302:1543–1550PubMedCrossRef

26.

Staehr AK, Meyhoff CS, Henneberg SW et al (2012) Influence of perioperative oxygen fraction on pulmonary function after abdominal surgery: a randomized controlled trial. BMC Res Notes 5:383PubMedCentralPubMedCrossRef

27.

Waldron NH, Jones CA, Gan TJ et al (2013) Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis. Br J Anaesth 110:191–200PubMedCrossRef

28.

Eberhart LH, Holdorf S, Albert US et al (2011) Impact of a single perioperative dose of dexamethasone on the incidence of surgical site infections: a case-control study. J Obstet Gynaecol Res 37:1807–1812PubMedCrossRef

29.

Daltrey DC, Rhodes B, Chattwood JG (1981) Investigation into the microbial flora of healing and non-healing decubitus ulcers. J Clin Pathol 34:701–705PubMedCrossRef

30.

Constantine BE, Bolton LL (1986) A wound model for ischemic ulcers in the guinea pig. Arch Dermatol Res 278:429–431PubMedCrossRef

31.

Rodeheaver GT, Pettry D, Thacker JG et al (1975) Wound cleansing by high pressure irrigation. Surg Gynaecol Obstet 141:357–362

32.

Lauwers S, de Smet F (1998) Surgical site infections. Acta Clin Belg 53:303–310PubMed

33.

Hourigan JS (2012) Impact of obesity on surgical site infection in colon and rectal surgery. Clin Colon Rectal Surg 24:283–290CrossRef

34.

Hennessey DB, Burke JP, Ni-Dhonochu T et al (2010) Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multi-institutional study. Ann Surg 252:325–329PubMedCrossRef

35.

Elek SD (1956) Experimental staphylococcal infections in the skin of man. Ann N Y Acad Sci 65:85–90PubMedCrossRef

36.

Junker T, Mujagic E, Hoffmann H et al (2012) Prevention and control of surgical site infections: review of the Basel Cohort Study. Swiss Med Wkly 142:w13616PubMed

37.

Ishibashi K, Kuwabara K, Ishiguro T et al (2009) Short-term intravenous antimicrobial prophylaxis in combination with preoperative oral antibiotics on surgical site infection and methicillin-resistant Staphylococcus aureus infection in elective colon cancer surgery: results of a prospective randomized trial. Surg Today 39:1032–1039PubMedCrossRef

38.

Mohri Y, Tonouchi H, Kobayashi M et al (2007) Randomized clinical trial of single- versus multiple-dose antimicrobial prophylaxis in gastric cancer surgery. Br J Surg 94:683–688PubMedCrossRef

39.

Togo S, Tanaka K, Matsuo K et al (2007) Duration of antimicrobial prophylaxis in patients undergoing hepatectomy: a prospective randomized controlled trial using flomoxef. J Antimicrob Chemother 59:964–970PubMedCrossRef

40.

DiPiro JT, Welage LS, Levine BA et al (1989) Single-dose cefmetazole versus multiple dose cefoxitin for prophylaxis in abdominal surgery. J Antimicrob Chemother 23(Suppl D):71–77PubMedCrossRef

Title: Pressurized Pulse Irrigation with Saline Reduces Surgical-site Infections following Major Hepatobiliary and Pancreatic Surgery: Randomized Controlled Trial
Authors: Mehrdad Nikfarjam
Laurence Weinberg
Michael A. Fink
Vijayaragavan Muralidharan
Graham Starkey
Robert Jones
Kevin Staveley-O’Carroll
Christopher Christophi
Publication date: 01-02-2014
Publisher: Springer US
Published in: World Journal of Surgery / Issue 2/2014
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-013-2309-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pressurized Pulse Irrigation with Saline Reduces Surgical-site Infections following Major Hepatobiliary and Pancreatic Surgery: Randomized Controlled Trial

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2014

Preparing for Prospective Clinical Trials: A National Initiative of an Excellence Registry for Consecutive Pancreatic Cancer Resections

Impact of the Reconstruction Method on Delayed Gastric Emptying After Pylorus-Preserving Pancreaticoduodenectomy: A Prospective Randomized Study

Re-Validating the Observational Teamwork Assessment for Surgery Tool (OTAS-D): Cultural Adaptation, Refinement, and Psychometric Evaluation

HER2 Expression in Carcinomas of the True Cardia (Siewert Type II Esophagogastric Junction Carcinoma)

Preparing for Prospective Clinical Trials: A National Initiative of an Excellence Registry for Consecutive Pancreatic Cancer Resections

Flow Disruptions During Trauma Care