Skip to main content
Top
Published in: Journal of Gastrointestinal Surgery 7/2010

01-07-2010 | Original Article

Prophylaxis and Management of Wound Infections after Elective Colorectal Surgery: A Survey of the American Society of Colon and Rectal Surgeons Membership

Authors: Katharine W. Markell, Ben M. Hunt, Paul D. Charron, Rodney J. Kratz, Jeffrey Nelson, John T. Isler, Scott R. Steele, Richard P. Billingham

Published in: Journal of Gastrointestinal Surgery | Issue 7/2010

Login to get access

Abstract

Background

Postoperative wound infections are a widespread and costly problem, especially in colorectal surgery. Despite their prevalence, there are few data regarding appropriate management and prevention strategies.

Materials and Methods

In order to assess current attitudes and practices about this subject, and as a guide to designing a randomized trial to gather evidence in order to support data-driven protocol development, an e-mail survey was sent to the membership of the American Society of Colorectal Surgeons to assess current attitudes and practices pertaining to prevention and management of wound infections.

Results

Most respondents estimated that the wound infection rate in their own patients was much lower than commonly reported in the literature. Use of evidence-based perioperative strategies for reducing wound infection, such as the use of a wound protector, hyperoxygenation, and implementation of the Surgical Care Improvement Project guidelines, were far from universal. Management strategies varied widely, without apparent rational basis.

Conclusion

Based on the practices and beliefs in the surgical community, it is our hope that a multi-institutional study can be carried out to objectify best practices in both the effective and cost-effective management of this common condition and to reduce the wide variation in the treatment of surgical site infections.
Literature
1.
go back to reference Bratzler DW, Houck PM, Richards C, Steele L, Dellinger EP, Fry DE, Wright C, Ma A, Carr K, Red L. Use of antimicrobial prophylaxis for major surgery: baseline results from the National Surgical Infection Prevention Project. Arch Surg 2005;140:174-182.CrossRefPubMed Bratzler DW, Houck PM, Richards C, Steele L, Dellinger EP, Fry DE, Wright C, Ma A, Carr K, Red L. Use of antimicrobial prophylaxis for major surgery: baseline results from the National Surgical Infection Prevention Project. Arch Surg 2005;140:174-182.CrossRefPubMed
2.
go back to reference Smith RL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG, Foley EF. Wound infection after elective colorectal resection. Ann Surg 2004;239:599-605.CrossRefPubMed Smith RL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG, Foley EF. Wound infection after elective colorectal resection. Ann Surg 2004;239:599-605.CrossRefPubMed
3.
go back to reference Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606-608.CrossRefPubMed Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606-608.CrossRefPubMed
4.
go back to reference Blumetti J, Luu M, Sarosi G, Hartless K, McFarlin J, Parker B, Dineen S, Huerta S, Asolati M, Varela E, Anthony T . Surgical site infections after colorectal surgery: do risk factors vary depending on the type of infection considered? Surgery 2007;142:704-711.CrossRefPubMed Blumetti J, Luu M, Sarosi G, Hartless K, McFarlin J, Parker B, Dineen S, Huerta S, Asolati M, Varela E, Anthony T . Surgical site infections after colorectal surgery: do risk factors vary depending on the type of infection considered? Surgery 2007;142:704-711.CrossRefPubMed
6.
go back to reference Ueno C, Hunt TK, Hopf HW. Using physiology to improve surgical wound outcomes. Plast Recon Surg 2006;117:59S-71S.CrossRef Ueno C, Hunt TK, Hopf HW. Using physiology to improve surgical wound outcomes. Plast Recon Surg 2006;117:59S-71S.CrossRef
7.
go back to reference Dryburgh N. Debridement for surgical wounds. Cochrane Database of Systematic Reviews. 2008;(4). Dryburgh N. Debridement for surgical wounds. Cochrane Database of Systematic Reviews. 2008;(4).
8.
go back to reference Ubbink D. Topical negative pressure for treating chronic wounds. Cochrane Database of Systematic Reviews. 2009;(4). Ubbink D. Topical negative pressure for treating chronic wounds. Cochrane Database of Systematic Reviews. 2009;(4).
9.
go back to reference Vermeulen H, Ubbink DT, Goossens A, de Vos R, Legemate DA. Dressings and topical agents for surgical wounds healing by secondary intention. Cochrane Database of Systematic Reviews. 2009;(4). Vermeulen H, Ubbink DT, Goossens A, de Vos R, Legemate DA. Dressings and topical agents for surgical wounds healing by secondary intention. Cochrane Database of Systematic Reviews. 2009;(4).
11.
go back to reference Hedrick TL, Heckman JA, Smith RL, Sawyer RG, Friel CM, Foley EF. Efficacy of Protocol Implementation on Incidence of Wound Infection in Colorectal Operations. J Am Coll Surg 2007;205:432-438.CrossRefPubMed Hedrick TL, Heckman JA, Smith RL, Sawyer RG, Friel CM, Foley EF. Efficacy of Protocol Implementation on Incidence of Wound Infection in Colorectal Operations. J Am Coll Surg 2007;205:432-438.CrossRefPubMed
12.
go back to reference Contant CM, Hop WC, van Sant HP, Oostvogel HJ, Smeets HJ, Stassen LP, Neijenhuis PA, Idenburg FJ, Dijkhuis CM, Heres P, van Tets WF, Gerritsen JJ, Weidema WF. Mechanical bowel preparation for elective colorectal surgery: a multicentre randomized trial. Lancet 2007;370:2112-2117.CrossRefPubMed Contant CM, Hop WC, van Sant HP, Oostvogel HJ, Smeets HJ, Stassen LP, Neijenhuis PA, Idenburg FJ, Dijkhuis CM, Heres P, van Tets WF, Gerritsen JJ, Weidema WF. Mechanical bowel preparation for elective colorectal surgery: a multicentre randomized trial. Lancet 2007;370:2112-2117.CrossRefPubMed
13.
go back to reference Guenaga KK, Matos D, Wille-Jorgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 2009;1:CD001544. Guenaga KK, Matos D, Wille-Jorgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 2009;1:CD001544.
14.
go back to reference Sookhai S, Recmond HP, Deasy JM. Impervious wound-edge protector to reduce postoperative wound infection: a randomized, controlled trial. Lancet 1999;353:1585.CrossRefPubMed Sookhai S, Recmond HP, Deasy JM. Impervious wound-edge protector to reduce postoperative wound infection: a randomized, controlled trial. Lancet 1999;353:1585.CrossRefPubMed
15.
go back to reference Horiuchi T, Tanishema H, Tamagawa K, et al. Randomized, controlled investigation of the anti-infective properties of the Alexis retractor/protector of incision sites. J Trauma 2007;62:212-215CrossRefPubMed Horiuchi T, Tanishema H, Tamagawa K, et al. Randomized, controlled investigation of the anti-infective properties of the Alexis retractor/protector of incision sites. J Trauma 2007;62:212-215CrossRefPubMed
16.
go back to reference Gallup DC, Gallup DG, Nolan TE, Smith RP, Messing MF, Kline KL. Use of a subcutaneous closed drainage system and antibiotics in obese gynecologic patients. Am J Obstet Gynecol 1996;175:358-361.CrossRefPubMed Gallup DC, Gallup DG, Nolan TE, Smith RP, Messing MF, Kline KL. Use of a subcutaneous closed drainage system and antibiotics in obese gynecologic patients. Am J Obstet Gynecol 1996;175:358-361.CrossRefPubMed
17.
go back to reference Grief R, Akca O, Horn EP, Kurz A, Sessler DI. Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. NEJM 2000;342:161-167.CrossRef Grief R, Akca O, Horn EP, Kurz A, Sessler DI. Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. NEJM 2000;342:161-167.CrossRef
18.
go back to reference Belda FJ, Aguilera L, García de la Asunción J, Alberti J, Vicente R, Ferrándiz L, Rodríguez R, Company R, Sessler DI, Aguilar G, Botello SG, Ortí R; Spanish Reduccion de la Tasa de Infeccion Quirurgica Group. Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial. JAMA 2005;294:2035-2042.CrossRefPubMed Belda FJ, Aguilera L, García de la Asunción J, Alberti J, Vicente R, Ferrándiz L, Rodríguez R, Company R, Sessler DI, Aguilar G, Botello SG, Ortí R; Spanish Reduccion de la Tasa de Infeccion Quirurgica Group. Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial. JAMA 2005;294:2035-2042.CrossRefPubMed
19.
go back to reference National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986-April 1996, issued May 1996. A report from the National Nosocomial Infections Surveillance (NNIS System). Am J Infect Control 1996;24:380-388. National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986-April 1996, issued May 1996. A report from the National Nosocomial Infections Surveillance (NNIS System). Am J Infect Control 1996;24:380-388.
20.
go back to reference Gemmell CG, Edwards DI, Fraise AP, Gould FK, Ridgway GL, Warren RE. Guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the UK. J Antimicrob Chemother 2006;57:589-608.CrossRefPubMed Gemmell CG, Edwards DI, Fraise AP, Gould FK, Ridgway GL, Warren RE. Guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the UK. J Antimicrob Chemother 2006;57:589-608.CrossRefPubMed
21.
go back to reference Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan EL, Montoya JG, Wade JC; Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis 2005; 41:1373-1406CrossRefPubMed Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan EL, Montoya JG, Wade JC; Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis 2005; 41:1373-1406CrossRefPubMed
22.
go back to reference Braakenberg A, Obdeijn MC, Feitz R, van Rooij IALM, van Griethuysen AJ, Klinkenbijl JHG. The clinical efficacy and cost effectiveness of the vacuum-assisted closure technique in the management of acute and chronic wounds: a randomized controlled trial. Plast Reconstr Surg 2006;118:390-397.CrossRef Braakenberg A, Obdeijn MC, Feitz R, van Rooij IALM, van Griethuysen AJ, Klinkenbijl JHG. The clinical efficacy and cost effectiveness of the vacuum-assisted closure technique in the management of acute and chronic wounds: a randomized controlled trial. Plast Reconstr Surg 2006;118:390-397.CrossRef
23.
go back to reference Gregor S, Maegele M, Sauerland S, Krahn JF, Peinemann F, Lange S. Negative pressure wound therapy: a vacuum of evidence? Arch Surg 2008;143:189-196.CrossRefPubMed Gregor S, Maegele M, Sauerland S, Krahn JF, Peinemann F, Lange S. Negative pressure wound therapy: a vacuum of evidence? Arch Surg 2008;143:189-196.CrossRefPubMed
24.
go back to reference Cook DJ, Guyatt GH, Laupacis A, Sackett DL. Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 1992;102(4 Suppl):305S–311S.CrossRefPubMed Cook DJ, Guyatt GH, Laupacis A, Sackett DL. Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 1992;102(4 Suppl):305S–311S.CrossRefPubMed
Metadata
Title
Prophylaxis and Management of Wound Infections after Elective Colorectal Surgery: A Survey of the American Society of Colon and Rectal Surgeons Membership
Authors
Katharine W. Markell
Ben M. Hunt
Paul D. Charron
Rodney J. Kratz
Jeffrey Nelson
John T. Isler
Scott R. Steele
Richard P. Billingham
Publication date
01-07-2010
Publisher
Springer-Verlag
Published in
Journal of Gastrointestinal Surgery / Issue 7/2010
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-010-1218-7

Other articles of this Issue 7/2010

Journal of Gastrointestinal Surgery 7/2010 Go to the issue