Superficial wound infection in Hepatopancreatobiliary (HPB) surgery
Research type
Research Study
Full title
Wound infection following Hepatopancreatobiliary (HPB) surgery – a measure of predictive surgical and transmission factors on patient outcomes
IRAS ID
220443
Contact name
Kathryn Whitehead
Contact email
Sponsor organisation
Manchester Metropolitan University
Duration of Study in the UK
3 years, 0 months, 4 days
Research summary
Research Summary
Surgical Site Infections (SSIs) remain the most common type of health care associated infection in the surgical population. Patients undergoing complex hepatopancreatobiliary (HPB) operations are at high risk for surgical site infection. Factors that contribute to these outcomes include preoperative, intraoperative, and postoperative variables. It is currently not know whether the major route of infection is from the patient themselves, or from transmission of persistent strains on the wards. Given the wide range of materials used in the design of a hospital ward, the transmission of pathogens from such surfaces to vulnerable patients may thus also be a considered factor in the incidence and prevalence of a particularly recalcitrant infection on a hospital ward. In order to reduce the incidence of SSIs the medical factors and potential transmission routes that may lead to an increased risk of infection need to be studied in depth. This project aims to evaluate a range of pre, intra and postoperative factors and hospital ward surfaces to determine if they potentially lead to an increase in SSIs. Since infection can be present in the absence of Systemic Inflammatory Response Syndrome (SIRS) indicators, the project will also analyse established markers of infection within the blood to determine if an infection has occurred but not been identified. An understanding and control of such factors will invariably lead to reduced incidences of hospital-acquired harm, reduced length of stay in acute care, avoidable morbidity and mortality, avoidable hospital admissions, a decrease in accident and emergency department attendance and an overall improved patient experience. This information will be used to advise NHS improvement channels and reduce the development of these infections in future patients following surgery.
Summary of Results
Surgical site infections (SSIs) occurred in 6/26 (23.1 %) of patients. The bacteria that were causing these infections were Citrobacter freundii, Enterobacter kobei, Enterobacter cloacae, Streptococcus milleri and Clostridium perfringens. The Enterobacter and Clostridium isolates were all AmpC and ESBL producing.
Other than Enterobacter cloacae these bacteria were all identified by the hospital in drain fluid and this suggests that organ/spaces SSIs contamination may have been from this site.
On the hospital surfaces, 24 different species were identified from all surfaces (55 isolates) 76.2 % were Gram positive cocci (mainly coagulase negative staphylococci) 52.7 % were multidrug resistant organisms (MDRO) – including methicillin resistant. The soap dispenser had 3 different MDR CoNS. The nurses’ computer keyboard was the most contaminated surface with 8 different species including MRSA. The second most contaminated area was the side of the floor with 5 different species including two potentially pathogenic Gram-negative bacilli (P. strutzeri and A. lwoffii). Much further work needs to be carried out to determine the extent and transmission routes of AMR bacteria into SSIs.REC name
South West - Central Bristol Research Ethics Committee
REC reference
18/SW/0077
Date of REC Opinion
12 Apr 2018
REC opinion
Further Information Favourable Opinion