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(CHI=54 [6.49%]; SWI=27[4.98%]) were preoperatively known MRSA carriers. Swiss patients (N=13)
were more likely than US patients (N=4) to develop MRSA SSIs (2.39% vs. 0.48%, p=0.002). However,
in the Swiss hospital, there were more emergency procedures (42% vs. 20%); the class of contamination
was higher (3.1 vs. 22); cancer was more prevalent (60% vs. 34%); and the postoperative hospital
stay was longer (15.9 ±16.3 vs. 8.3±7.1, p>0.001).
Conclusion: The incidence of MRSA infection after colorectal surgery is low (1.2%) and the majority
(69%) of infected patients were MRSA-free on admission and were colonized during hospitalization.
Altogether, these data suggest that the prevention of MRSA infection after colorectal surgery should
rely more on the application of basic surgical basic principles than on vancomycin use for prophylaxis.
18.3
Perioperative nutrition is still a surgical orphan
F. Grass, M. Hübner, Y. Cerantola, S. Müller, M. Schäfer, N. Demartines (Lausanne)
Objective: To assess if screening programs and treatment of preoperative malnutrition have been implemented
into surgical practice to decrease morbidity. There is strong evidence that postoperative
morbidity can be minimized by early identifying and treating patients at nutritional risk before major surgery.
The validated nutritional risk score (NRS) is recommended by the European Society of Parenteral
and Enteral Nutrition for nutritional screening. It remains unclear whether routine preoperative nutritional
assessment and perioperative nutrition is widely implemented.
Methods: A survey was conducted in 173 Swiss and Austrian surgical departments. Implementation
of nutritional screening, perioperative nutrition, and estimated impact on clinical outcome were assessed.
Non-responders were repeatedly contacted by the authors.
Results: The overall response rate was 55%, whereby 69% (54 / 78) of Swiss and 44% (42 / 95) of
Austrian centers responded. Despite 80% and 59% of the responding centers are aware of a reduced
complication rate and shortened hospital stay, respectively, only 20% of them implemented routine
nutritional screening. Financial (49%) and logistic restrictions (33%) are the predominant reasons
against the routine clinical use. Screening is mainly performed either in the outpatient’s clinic (52%)
or during admission (54%). The NRS is only used by 14%. Instead, various clinical (78%), e.g. BMI and
laboratory findings (56%), e.g. albumine, are used. Indication for perioperative nutrition is based on
preoperative screening in 49%. While 23% use preoperative nutrition, 68% apply nutritional support
pre- and postoperatively. Preoperative nutritional treatment ranged from three days (33%), to five days
(31%) and even seven days (20%).
Conclusion: Despite malnutrition is well recognized as major risk factor for increased postoperative
morbidity, the majority of surgeons are reluctant to implement routine screening and nutritional support.
If nutritional assessment is performed, local institutional screening parameters are still preferred.
It remains difficult to overcome traditions, and to change surgeon’s mind.
18.4
Association of noise volume in the operating room with surgical site infections
A. Kurmann 1 , M. Peter 1 , F. Tschan-Semmer 2 , D. Candinas 1 , G. Beldi 1 ( 1 Berne, 2 Neuchâtel)
Objective: In a previous study we showed that the subjective perception of noise in the operating room
was associated with surgical site infections. In the present study we hypothesized that noise volume
in the operating room represents a surrogate marker of incidence on surgical site infections (SSI).
Methods: Noise volume was measured during 35 elective open abdominal procedures. All involved
personnel was previously informed. The microphone of the noise measuring device (PCE 353 ® , PCE
GmbH & Co.KG, Germany) digitally registered every second the volume in decibel (dB) just below the
surgical lamps above the patient. Elevations of noise volume above baseline were assessed. A standardized
questionnaire was filled out to evaluate discipline of the operating room team. Main outcome
measure was the incidence of SSI 30 days after surgery.
Results: Overall rate of SSI was 17% (6/35). Demographic parameters including gender, age, BMI,
and operative time were not significantly different between patients with or without SSI. Median noise
volume above baseline was significant higher in patients with surgical site infections (43.5 dB, range
26-60 dB vs. 25 dB, range 25-60 dB; p=0.04). Peaks ≥ 4dB over the baseline values were found in
22.45% with SSI versus 10.7% in patients without SSI (p=0.02). The discipline score showed that talking
about non operative specific topics was associated with a significant higher sound level (p=0.02).
Whereas changing of surgical team members or talking about operative specific topics are not associated
with a higher sound levels.
Conclusion: In this study we show an association between intraoperative noise volume and SSI. We
propose that intraoperative noise may represent a surrogate parameter of various factors such as a
difficult operation, lack of discipline, lack of concentration or a stressful environment in general that in
turn might elevate the incidence of SSI.
18.5
Surgical site infection – a 10 year results‘ analylsis and strategy in a peripheral Swiss hospital
M. Giuliani, S. Schlunke, J. Al-Muaid, D. Brasola, P. Biegger (Locarno)
Objective: Surgical site infections (SSI) are well known, being the second most frequent nosocomial
infection worldwide. Highly resistant pathogen germs, an aging population and the economic pressure
on our healthcare system require a clear statement. According to the reviewed literature, there is a positive
correlation between the hospital size and SSI. Unlike other well demonstrated factors, the careful
surgical handling of tissues seems to have a crucial, yet not well documentable importance.
Methods: We present our data, collected over a period of 7 years by a hospital independent source
(Institut Central Service des Maladies Infectieuses Canton du Valais), setting benchmarks with over
14‘000 similar operations from 18 different hospitals (appendectomy, cholecystectomy and colon
resections).
Results: 196 appendectomies, 320 cholecystectomies and 293 colon resections are reviewed in detail.
Despite having a more severe NNIS score (wound contamination score, ASA classification), our
infection rates have constantly remained remarkably low over the years and our RR and OR (CI 95%)
are significantly lower than the benchmark. We comment the results of the study and explain our strategy
in surgical practice.
Conclusion: Apart from common measures like oxygenation, warming up during surgical interventions
and prophylactic antibiotic administration, what also counts equally in our opinion ist the standardization
of procedures, cautious dissection and meticulous tissue handling, as the key to these constant
satisfying results - offering at the same time an optimal basis for teaching specific surgical knowledge
to younger colleagues. In a world becoming more and more technology-dependent, the importance of
surgical knowhow and tissue handling should not be missed.
18.6
Risk factor analysis for surgical site infection after excision and primary closure of pilonidal sinus
S.-G. Popeskou, D. Christoforidis, C. Ruffieux, N. Demartines (Lausanne)
Objective: Excision and primary closure for pilonidal sinus disease is associated with a high rate of
surgical site infection (SSI). The aim of our present study was to assess the risk factors for SSI in this
context.
Methods: All consecutive patients undergoing excision and primary closure of pilonidal sinus between
2002 and 2008 were analyzed retrospectively. SSI was defined according to the Center for Disease
Control criteria. We performed uni- and multivariate analysis of risk factors including sex, age, smoking,
BMI, type of pilonidal sinus, use of perioperative antibiotic prophylaxis, methylene blue or surgical drain.
Results: Out of 157 consecutive patients 131 (83%) had complete charts and were included in the
study (men, 74.1%, age 24 (15-66)). SSI was observed in 41(31%) patients. Median time to healing
was 20 days (12-76) in patients without SSI vs. 62 days (20-170) in patients with SSI (p