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Study: Dangerous Surgical Site Infections Can Be Reduced With Simple Prevention Protocol
A new study published in the American Journal of Infection Control demonstrates the use of a simple pre-surgical infection prevention protocol to prevent dangerous post-surgical infections. Researchers performed this investigation at the Soroka University Medical Center in Israel.
Surgical site infections (SSIs) are a type of health care-associated infection with deadly consequences for some patients. According to the latest data from the Centers for Disease Control and Prevention, there were more than 110,000 SSIs linked to inpatient surgeries in the U.S. In 2015. These infections lead to a high rate of morbidity and mortality, with a patient's estimated risk of death as much as 11 times higher than normal. SSIs also have a very high financial burden, with the average hospital stay extended by nearly 10 days and an estimated $20,000 in additional hospitalization costs per patient.
There are a number of recommended protocols to help prevent SSIs, but lack of patient compliance, high costs, and bacterial resistance can reduce their utility and effectiveness. In this new study, researchers aimed to evaluate the results of a protocol designed to reduce SSIs through a particular focus on the Staphylococcus aureus pathogen. The approach involved a pre-surgical intranasal application of povidone-iodine and skin antisepsis using chlorhexidine gluconate (CHG).
The study involved 688 adult patients who had hip or knee arthroplasty or spine surgery at Soroka University Medical Center between February 2018 and October 2021. Their outcomes were compared to a retrospective patient cohort from 2016 and 2017 treated before the povidone-iodine component of the protocol was implemented. Patient outcomes were tracked for 90 days after surgery.
Deploying this intervention prior to surgery helped to address a broad challenge in health care, that some 30% of the population is colonized with S. Aureus without exhibiting symptoms. The pre-surgical protocol successfully eradicated S. Aureus in nearly 40% of patients found to already harbor the pathogen.
This is particularly important for patient outcomes, as the researchers found that the presence of S. Aureus within the day following surgery was associated with a three-fold risk of developing an SSI. Overall, the study showed a significant decrease in severe SSIs among patients who received the newer protocol.
"Our study clearly shows that we can prevent surgical site infections and keep patients safer through the use of a simple pre-surgical nasal application of povidone-iodine in combination with standard CHG bathing," said Lisa Saidel-Odes, MD, Infectious Diseases specialist at Soroka University Medical Center and lead author of the paper. "We noted that the protocol is most effective in cases with little S. Aureus present and suggest that an additional application of the povidone-iodine might be needed for patients with greater nasal colonization."
Additional details from the study:
"This study shows the power of applying widely available antiseptics to reduce SSIs and improve patient safety," said Tania Bubb, Ph.D., RN, CIC, FAPIC, 2024 APIC president. "The results are encouraging not only because the regimen is effective in reducing SSI, but also because it is simple to implement and avoids the risk of antibiotic resistance."
More information: Getting the Drop on Staphylococcus aureus: Semi-Quantitative Staphylococcus aureus Nasal Colony Reduction in Orthopedic Surgery Reduces Surgical Site Infection, American Journal of Infection Control (2024). DOI: 10.1016/j.Ajic.2024.02.014
Provided by Association for Professionals in Infection Control
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(Pet Talk) A Closer Look Into Cryptococcal Fungal Infections
Allowing pets to roam outdoors can seem like harmless fun, providing them with exercise, mental stimulation and a chance to explore.
Some environments, however, pose hidden dangers that pet owners may not immediately recognize, such as the risk of cryptococcal fungal infections which can infect the lungs, brain, and other parts of the body.
Dr. Sara Lawhon, director of the Clinical Microbiology Laboratory for the Veterinary Medical Teaching Hospital at the Texas A&M School of Veterinary Medicine & Biomedical Sciences, provides insight into this type of fungal infection and why pet owners should be aware of the potential harm it poses to their pets — and especially cats.
Susceptibility and signsCryptococcal fungal infections are caused by the Cryptococcus species of fungi, most commonly Cryptococcus neoformans and Cryptococcus gattii. These fungi are most naturally found in warm and humid environments, particularly where soil, decaying organic material (such as wood, leaf litter and compost), and bird droppings are present.
"Both cats and dogs can develop serious, even life-threatening, cryptococcal infections when they inhale the spores of the fungi, but this type of infection is more commonly associated with cats," Lawhon said. "Cats of all ages, breeds and sex can be affected, and infections have been reported in both indoor and outdoor cats."
While outdoor cats are more likely to be exposed to the fungi, owners or other animals can bring contaminated materials on their shoes or clothes, introducing the fungus to indoor cats.
The most common form of cryptococcal fungal infections in cats affects the nasal cavity and sinuses, with early symptoms including swelling of the nose and face.
"Cats with this form of the infection can develop deep, non-healing ulcers of the skin and chronic nasal discharge that is clear, bloody, or full of pus; inflammation of the nasal tissues may result in sneezing or difficulty breathing as well," Lawhon said. "Though not typically painful, C. Neoformans can cause skin lesions including nodules in the skin, which are small, raised bumps."
When cats have nasal cryptococcosis, Lawhon says they can lose weight, not only due to effects of the fungus on the body, but also because of their decreased sense of smell and interest in food.
Infections that are not promptly addressed may spread to other parts of the body, including in the lungs or central nervous system.
"Cats with disease in their central nervous system can specifically experience blindness, seizures, or changes in their behavior," Lawhon said. "In some cases, cats will continue to develop the disease throughout the rest of the body."
Proactive veterinary and owner careIt is important for owners to seek veterinary care as soon as they notice any concerning symptoms in their cats because, as Lawhon pointed out, it can be harder to treat patients once the infection has spread to the central nervous system or throughout the body.
"The outlook for patients with nasal cryptococcosis is often better but usually requires several months of treatment with antifungal drugs," Lawhon explained. "Veterinarians will diagnose cryptococcal fungal infections based on the patient's history and clinical signs while confirmation of the diagnosis is made by testing samples from the affected areas or identifying cryptococcal proteins in a blood sample."
There is currently no vaccine available for cryptococcal fungal infections, making prevention efforts all the more important.
"Limiting a cat's exposure to environments with decaying plant material and bird droppings is likely to reduce the risk of infection," Lawhon said.
Outdoors can be a source of joy and exploration for pets as long as owners can ensure their pet's safety and well-being. By understanding the signs of cryptococcal fungal infections, cat owners, in particular, can act swiftly to seek veterinary care and improve the outcome for their beloved pets.
What Are Lymph Nodes?
Lymph nodes are located throughout the body. They are small, bean-shaped glands that play a crucial role in the immune system. During an infection, a person may notice swollen lymph nodes.
The body contains hundreds of lymph nodes. They form clusters around the body and are particularly prominent in areas such as the neck, armpit, groin, and behind the ears.
They filter lymphatic fluid, which helps rid the body of germs and remove waste products.
The body's cells and tissues dispose of waste products in lymphatic fluid, which lymph nodes filter. During this process, they catch bacteria and viruses that could harm the rest of the body.
Lymph nodes are an essential part of the body's immune system. Due to their function, they come into contact with toxins, which can cause them to swell. Although swollen lymph nodes are common, they may occasionally indicate lymph node cancer or lymphoma.
Keep reading to learn more about lymph nodes and their function within the immune system.
Lymph nodes are part of the lymphatic system, which is a complex network of nodes and vessels.
In certain areas of the body, such as the neck, armpit, and groin, lymph nodes sit close to the skin. This means a person may feel them swell when an infection develops.
Lymph nodes are also present in the stomach and between the lungs. However, there are no lymph nodes in the brain or spinal cord.
The name of a lymph node depends on its location in the body.
Learn more about lymph nodes.
Lymph nodes form clusters throughout the body. Their main function is to filter out potentially harmful substances.
All tissues and cells in the body excrete lymphatic fluid, or lymph to eliminate waste products. The lymph then travels through vessels in the lymphatic system and passes through lymph nodes for filtering.
Lymph nodes contain lymphocytes. These are a type of white blood cells that help destroy pathogens, such as bacteria, viruses, and fungi. When lymph nodes detect a pathogen in the lymph, they produce more lymphocytes, which causes them to swell.
Upon encountering bacteria or damaged cells, lymph nodes destroy them and turn them into a waste product.
When the lymph reenters the bloodstream, waste products travel to the kidneys and liver. The body then excretes waste products in the urine and feces.
Learn more about how the lymphatic system works.
Swollen lymph nodes do not always indicate cancer.
Below, we list some conditions that can cause lymph node swelling and their associated symptoms.
LymphadenitisLymphadenitis occurs when bacteria, viruses, or fungi in the lymph infect lymph nodes. When this happens, lymph nodes swell and are painful to the touch.
If multiple clusters of nodes become infected, a person may feel pain and swelling in their neck and groin.
Most of the time, people experience localized lymphadenitis. This means the condition only affects a few nodes. If the infection occurs in several node clusters, a doctor will likely diagnose generalized lymphadenitis.
The condition usually results from an infection elsewhere in the body.
SymptomsSymptoms of lymphadenitis include:
Lymphadenitis treatments include:
The type of treatment necessary will depend on various factors, such as the severity of the disease and a person's underlying conditions and allergies. A doctor will help a person choose the most suitable treatment based on these factors.
Learn more about swollen lymph nodes in the neck.
Viral or bacterial throat infectionsSwollen lymph nodes in the neck may be due to a viral or bacterial throat infection, such as strep throat.
Viral infectionsViral throat infections, such as colds, can present with swollen lymph nodes, a runny nose, and pinkeye.
These infections usually resolve on their own. However, a person can take over-the-counter pain medications to alleviate pain they may experience when swallowing.
Strep throatStrep throat is a bacterial infection that develops in the throat and tonsils due to group A streptococcus. People may contract the infection if they come into contact with droplets containing the strep bacteria.
A person with strep throat may experience swollen lymph nodes on the neck, as well as:
Doctors treat strep throat with antibiotics.
Learn more about what causes a sore throat and swollen glands.
ImpetigoImpetigo is an infection that develops due to group A streptococcus and may cause lymph nodes to swell.
The bacteria can enter the skin directly or through breaks in the skin, for example, through a minor cut or rash.
SymptomsSymptoms of impetigo include:
If a person has impetigo, they should seek medical attention to address their symptoms and prevent the condition from spreading to others.
Treatment will usually involve antibiotics.
Learn about what else can cause a rash and swollen lymph nodes.
RingwormRingworm, or jock itch, is a fungal infection that can affect many areas of the body. If the fungus develops in the groin, a person may experience swollen lymph nodes in that area.
Typically, ringworm starts as a fungal lesion. The fungus often spreads from person to person through the use of shared towels.
Ringworm thrives in moist environments; therefore, a person should dry thoroughly after washing or swimming and try not to stay in damp clothes.
SymptomsCommon ringworm symptoms include:
A doctor will prescribe an antifungal treatment to address ringworm.
The best way to prevent ringworm is to wear breathable fabrics, avoid sharing towels and personal equipment, and dry thoroughly after bathing.
Learn more about swollen lymph nodes in the groin.
Lymphoma is a type of cancer that affects the lymphatic system. The two main types of lymphoma are Hodgkin lymphoma and non-Hodgkin lymphoma.
SymptomsTypical symptoms of lymphoma include:
These are also common symptoms of viral infections, making it challenging for doctors to diagnose lymphoma. However, in people with lymphoma, symptoms tend to persist for longer periods.
These symptoms do not clearly indicate cancer. If a person experiences any of these, they should contact a doctor to identify the cause of their symptoms.
TreatmentTreatment options for lymphoma include:
Learn more about cancer in the lymph nodes.
A person should contact a healthcare professional if they are experiencing persistent swelling of lymph nodes.
Swelling usually indicates an infection, so a person should not immediately worry about lymphoma.
After reaching a diagnosis, a doctor will recommend the appropriate course of treatment.
The following are some commonly asked questions about lymph nodes.
What can cause swollen lymph nodes?Common causes of swollen lymph nodes include common temporary illnesses, such as colds or throat infections. Viral infections, such as infectious mononucleosis, may also cause lymph nodes to swell. In rare cases, the cause may be more serious, such as cancer.
What does lymphoma in the armpit look like?Lymphoma in the armpit may look like a swollen lump. It is typically painless. A biopsy is the only way to determine whether lymphoma is the cause. A person should visit a doctor if the lump is larger than 1.5 centimeters (cm) in diameter, they have multiple lumps, or lumps in various locations.
Where are cancerous lymph nodes located?Cancer can affect lymph nodes throughout the body. Some lymph nodes, such as those in the neck, armpit, and groin, are near the skin's surface, so a person may see or feel them when they swell.
Lymph nodes are a part of the lymphatic system. They filter lymph, which contains pathogens and damaged cells, and send the dead cells to the kidneys and liver.
Lymph node swelling usually results from an infection. In rare cases, however, it may be due to lymphoma.
If a person is concerned about swelling and other symptoms, they should contact a doctor.
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