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Antimicrobial Resistance and Infection Control 2019, 8(Suppl 1):148 https://doi.org/10.1186/s13756-019-0567-6 MEETINGABSTRACTS Open Access Abstracts from the 5th International Conference on Prevention & Infection Control (ICPIC 2019) Geneva, Switzerland. 10-13 September 2019 Published: 9 September 2019 Slide session: Surgical Site Infection O2 O1 IMPACT OF CLIMATE FACTORS ON SURGICAL SITE INFECTION RATES. DATA FROM 17 YEARS OF SURVEILLANCE IN GERMANY THE EFFECT OF POSTOPERATIVE CONTINUATION OF ANTIBIOTIC 1 1 2 1 PROPHYLAXIS ON THE INCIDENCE OF SURGICAL SITE INFECTION: A S. J. S. Aghdassi , F. Schwab , P. Hoffmann , P. Gastmeier 1 – SYSTEMATIC REVIEW AND META-ANALYSIS Institute of Hygiene and Environmental Medicine, Charité S. De Jonge1, Q. Boldingh1, J. Solomkin2, P. Dellinger3, M. Egger4,G. Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, 4 5 1 Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin; Salanti , B. Allegranzi , M. Boermeester 2 1Surgery, Amsterdam UMC, Amsterdam, Netherlands; 2Surgery, University Potsdam Institut für Klimafolgenforschung, Potsdam, Germany of Cincinnati , Cincinnati; 3Surgery, University of Washington, Seatle, Correspondence: S. J. S. Aghdassi United States; 4Institute for Social and Preventive Medicine, University of Antimicrobial Resistance and Infection Control 2019, 8(Suppl 1):O2 Bern, Bern; 5Infection Prevention and Control Global Unit, World Health Organization, Geneva, Switzerland Introduction: Surgical site infections (SSI) are among the most fre- Correspondence: S. De Jonge quent healthcare-associated infections in German hospitals. Besides Antimicrobial Resistance and Infection Control 2019, 8(Suppl 1):O1 well-known patient-related and procedure-related risk factors for SSI, a focus has been placed recently on other risk factors, including sea- Introduction: Surgical antibiotic prophylaxis (SAP) is frequently con- son and temperature. tinued for several days after surgery to prevent surgical site infection Objectives: Our objective was to determine how selected climate (SSI).Continuing SAP after the operation may have no advantage factors influence SSI-rates and for which SSI-causing pathogens ef- compared to immediate discontinuation and unnecessarily expose fects of climate factors are most noticeable. patients to risks associated with antibiotic use. In 2016, the World Methods: SSI-rates were calculated for procedures included in the Health Organization (WHO) recommended discontinuation of SAP. German SSI surveillance system, which were conducted in the years Objectives: We present an update of the evidence that formed the 2000-2016. The procedures were associated with department- and basis for this recommendation. patient-related data. To investigate the impact of climate factors, Methods: For this systematic review and meta-analysis we searched data on temperature, precipitation, and other meteorological param- MEDLINE, Embase, CINAHL, CENTRAL, and WHO regional medical data- eters provided by the German Meteorological Service were utilised. bases from Jan 1990 to August 2018 for randomised controlled trials Postcodes were used to match climate data and surveillance data. (RCT) comparing the effect of postoperative SAP continuation to its dis- Due to a high correlation with other climate factors, analyses were continuation. We excluded studies comparing regimens that also differed executed with a focus on temperature. A descriptive analysis was with regard to dose and agent used, and studies that did not administer conducted using chi-squared test. Through multivariable logistic re- the first dose preoperatively by intravenous infusion. We extracted data gression adjusted odds ratios (AOR) were calculated for SSI-rates in from published reports and contacted the authors if important informa- reference to the mean temperature (both as a categorical and a con- tion was missing. We combined studies using random effects meta- tinuous variable) during the month of surgery. A p-value of <0.05 analysis. We planned subgroup analyses and meta-regression for studies was considered significant. adhering to current standards of practice in SAP. Results: Altogether 2,004,793 procedures and 32,118 SSI (13,811 superfi- ≥ Results: We identified 83 relevant RCTs. The main meta-analysis in- cial and 18,307 deep) were included. Temperatures 20°C were associ- cluded 52RCTs with 19,273 participants.ThecombinedrelativeriskofSSI ated with a significantly higher SSI-risk than temperatures <5°C (AOR comparing postoperative SAP continuation with discontinuation was 0·89 1.132). This was observed for SSI caused by gram-positive and gram- (95% confidence interval: 0·79-1·00). There was little heterogeneity (tau2: negative bacteria. This association was most prominent for superficial SSI 0·001). Subgroup analysis showed that the effectiveness of postopera- with gram-negative pathogens (AOR 1.378). When viewed as a continu- tively discontinued SAP depends on appropriateness of SAP practices. ous variable, we found that an increase of 1°C in mean temperature re- When SAP best practices (i.e., timely administration of the first dose and sulted in a 0.7% higher overall SSI-risk. redosing when indicated according to the procedure duration) were ap- Conclusion: Climate factors influence SSI-rates. Higher temperatures plied, there was no benefit of postoperative SAP continuation in reducing increase the risk of SSI, this effect is especially caused by tempera- ≥ SSI compared to discontinuation of SAP. tures 20°C which seem to represent a threshold. The expected rise Conclusion: There is no strong evidence for a benefit of postopera- of global temperatures until the end of the century when compared tive continuation of SAP. These findings support WHO recommenda- to preindustrial conditions may increase the incidence of SSI and its tions against this practice. A protocol for this review was registered effect has to be recognised when developing future SSI-prevention with at PROSPERO:CRD42017060829. strategies. Disclosure of Interest: None declared Disclosure of Interest: None declared © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Antimicrobial Resistance and Infection Control 2019, 8(Suppl 1):148 Page 2 of 201 O3 Methods: All patients undergoing craniotomy from 2013-2017 were in- REDUCING STAPHYLOCOCCUS AUREUS SURGICAL SITE INFECTIONS cluded. Post-discharge surveillance was carried out actively up to 1 year USING AN ANTI-STAPHYLOCOCCAL BUNDLE IN NEW ZEALAND post-surgery. Incidence of SSI-CRAN before and after the SCB implementa- N. Grae, A. Morris, S. Roberts tion was measured. Main SCB measures were: preoperative shower, ap- 1Infection Prevention & Control Programme, New Zealand Health Quality propriate hair removal, 1g vancomycin powder in the subgaleal space & Safety Commission, Wellington, New Zealand and a sterile absorbent drape to cover the surgical wound. Given the lack Correspondence: N. Grae of randomization, a propensity score (PS) matching 1:1 of receiving SCB Antimicrobial Resistance and Infection Control 2019, 8(Suppl 1):O3 was estimated. Results: 1017 patients included, 595 pre-SCB period and 422 SCB Introduction: Staphylococcus aureus (S. aureus) is a major cause of period. The overall prevalence of SSI-CRAN in SCB period was lower cardiac and orthopaedic surgical site infections (SSIs) in New Zealand (15.3%vs.3.5%, p<0.001). For the PS, 421 pairs were matched. Multi- (NZ). A preoperative bundle to reduce S. aureus SSIs has been imple- variate Cox PS-matched analysis of factors associated with SSI-CRAN mented in many countries; the evidence supporting this is of moder- found that SCB implementation (AOR:0.23, 95% CI:0.13–0.40; p< ate quality. A quality improvement (QI) collaborative to develop and 0.001) and CSF leak (AOR:3.93, 95% CI:1.11–12.68; p=0.025) were in- implement a preoperative anti-staph bundle to reduce S. aureus SSI dependently associated with this complication. rates in target surgical procedures was established. Conclusion: The implementation of a SCB was effective in reducing Objectives: The aim of the collaborative was to implement an anti- the incidence rates of SSI-CRAN in a tertiary university hospital. Hos- staph bundle in different clinical pathways (cardiac and orthopaedic pitals should embrace strategies to increase SCB compliance. surgery) across numerous hospitals. Methods: Eight publicly funded and private surgical hospitals were Disclosure of Interest: None declared recruited. The ten-month collaborative included three one-day learn- ing sessions, monthly webinars, one-to-one teleconferences, and site visits. The key components of the bundle included pre-operative skin O5 and nasal decolonisation. The choice of agents and method of deliv- MANAGEMENT AND OUTBREAK INVESTIGATION OF SERRATIA ery was at the discretion of the respective teams. Education, auditing, MARCESCENS NEUROSURGICAL SITE INFECTIONS ASSOCIATED and documentation tools were developed and shared across all WITH
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