The Journal of Hospital Infection - Supplement 1 - November 2016

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demonstrated that staples are associated with an increased risk of SSI.
The morbidity associated SSI that may be increased with the use of
staples would outweigh the increase in time required for closure with
sutures.
Aim(s)/Objective(s): To evaluate the risks of surgical site infection
(SSI) after caesarean-section wound closure with surgical staples
versus absorbable subcuticular suture.
Method(s): NHS hospitals in Northern Ireland performing c-sections
are mandated to perform prospective SSI surveillance during
the inpatient stay and in the community setting. CDC-NHSN defi-
nition of SSI was used. Information collected included age, BMI,
previous c-sections, ASA-score, urgency of operation, closure used,
procedure duration and antibiotic prophylaxis. We compared SSI rates
for staple and suture closure, in low transverse C-sections, during
2008 –2015.
Results: 39,752 C-sections were included; 29,834 received sutures and
9,918 had staples. Of those closed with staples, 0.8% developed an SSI
in hospital, compared to 0.4% in the sutures group (p < 0.001). At the
end of community follow-up the incidence was 12.1% in the staple
group and 9.3% in the suture group (p < 0.001). Median operative time
was longer in the suture group compared with staples (37 vs. 35
minutes).
Discussion and/or Conclusion(s): This is one of the largest studies to
demonstrate that staple closure was associated with significantly
higher SSI rates compared with suture closure.
ID: 4656
Surgical site infections (SSIs) after spinal surgery in
university-associated pediatric hospital: Impact of nutritional
insufficiency?
Marie-Laure Valdeyron1, Vincent Cunin2, Christine Bruchon3,
Selilah Amour4, Anne Tristan5, Isabelle Poirot6, Jacqueline Grando3,
Noel Peretti7, Philippe Vanhems8. 1Unité d’Hygiène et d’ Epidémiologie
Hospices Civils de Lyon – Groupement Hospitalier Est, 2Service de
chirurgie pédiatrique, Hospices Civils de Lyon, Groupement Hospitalier
Est, 3Unité d’ Hygiène et d’Epidémiologie Hospices Civils de Lyon,
Groupement Hospitalier Est, 4Unité d’Hygiène et d’Epidémiologie
Hospices Civils de Lyon, Groupement Hospitalier Centre, 5Laboratoire de
microbiologie, Hospices Civils de Lyon, Groupement Hospitalier Est,
6Service de rééducation pédiatrique, Hospices Civils de Lyon, Groupement
Hospitalier Est, 7Service de gastro entérologie pédiatrique, Groupement
Hospitalier Est des Hospices Civils de Lyon, 8Service Hygiène
Epidémiologie et Prévention, Groupement Hospitalier Sud des Hospices
Civils de Lyon, Saint Genis Laval, France
Background: Wound infections are a serious complication of
spinal fusion, often requiring re-operation and prolonged antibiotic
therapy.
Aim(s)/Objective(s): The objectives were to determine the rate of
Surgical Site Infections (SSIs) after spinal surgery, to identify the
risk factors (RF) associated with SSIs and to suggest corrective
means.
Method(s): SSIs had been identified by active prospective surveillance.
RF were collected retrospectively. Multivariate analysis was per-
formed. The setting was a university-associated pediatric hospital.
Patients were children aged from 4 to 25 years old with a neuro-
muscular or idiopathic scoliosis, who underwent spinal surgery
between 01/01/2011 and 31/12/2015.
Results: There were 21 infections following 326 fusions (6.4 per 100
operations). The sex ratio (M/F) was 0.41. The yearly SSIs attack rates
were 1.6%, 10.3%, 5.7%, 4.2% and 10.5%. The mean age of infected
(Inf.) and not infected (N. inf.) patients were similar (16.2 years)
in both groups. The infection involved S. aureus (46%) and
enterobacteriae (28%). Concerning patient-associated RF, there were
statistical difference for the weight (Inf.: 36.4 ± 19.3 kg; N. inf.:43.5 ±
15.3 kg; p = 0.008), and the size (Inf.:142.8 ± 21.8 cm; N. inf.:150.8 ±
17.7 cm; p = 0.041). If the Body Mass Index is inferior to 15 kg/m 2,
the rate ratio was 4.09 (95%CI: 1.5–10.7; p = 0.004) and with
multivariate analysis, only this condition was a RF (95%IC: 0.117;
0.884; p = 0.028). ASA score was also a RF (Chi2 test: p = 0.048).
Concerning surgery-associated RF, the mean duration of surgery
was statistically different (Inf.: 270 ± 68 cm; N.inf: 231 ± 86 cm;
p = 0.011).
Discussion and/or Conclusion(s): Our results suggest to decolonize
patients with mupirocine five days before surgery and to offer them an
enteral nutrition one year before intervention.
ID: 4681
Measuring compliance with infection prevention practice across
the surgical pathway: pilot study of the OneTogether Assessment
Toolkit
Jennie Wilson1, Kathryn Topley2, Deborah Xuereb3, Tracey Radcliffe4,
Deborah Pike5, Sophie Singh2, Dawn Stott6, Reg Lloyd7, Ruth Collins8.
1University of West London, 23M, 3Mater Dei Hospital, Malta; 4Betsi
Cadwaladr University Health Board, 5College of Operating Department
Practitioners, 6Association of Preoperative Practitioners, 7NHS Lothian,
8Belfast Health & Social Care Trust
Background: OneTogether is a collaboration between professional
organisations focused on the prevention of surgical site infection. A
lack of knowledge and variation in application of guidance had been
identified as barriers to implementation of infection prevention
practice (IPP) in theatres. To address this we developed an assessment
toolkit for systematic evaluation of adherence to IPP across the surgical
pathway.
Aim(s)/Objective(s): To undertake a pilot study of an assessment
toolkit for assuring practice for SSI prevention.
Method(s): An assessment framework of seven IPP standards was
developed, based on evidence-based guidance and divided into
discrete elements. Each element measured standard ‘ present’ and
‘applied’ and was scored as 2 (compliant), 1 (partially compliant), 0
(non-compliant). Performance was measured as percentage compli-
ance for each standard. Pilot study participants were recruited by the
partnership and chose the theatre specialties to assess. Data was
captured on practical problems encountered, ease of application/
interpretation, and omissions.
Results: The toolkit was used by seven hospitals in 15 theatres. Overall
compliance was 62.1% (range 47.1– 88.9%); scores were higher for
standard ‘applied’ (77.4%) than ‘defined ’ (67.3). Compliance scores
were highest for instrument asepsis (96%) and lowest for pre-op
warming (42%), skin disinfection (55%) and surgical environment
(58%). The toolkit was reported as easy to use and valuable for
identifying gaps in IPP.
Discussion and/or Conclusion(s): This pilot study has demonstrated
non-compliance with recommended IPP for surgical patients and
found that the assessment tool was valuable for identifying and
addressing deficiencies. The toolkit has been revised to incorporate
feedback from the pilot study and the final version made available.
ID: 4716
Review of neurosurgical spinal infections in Queen Elizabeth
University Hospital, Glasgow from 1st January 2015 to 31st
August 2015
Hannah Soulsby1, Christine Peters2, Teresa Inkster2. 1Greater
Glasgow and Clyde NHS Trust, 2Queen Elizabeth University Hospital,
Glasgow
Background: Documented infection rates vary with the type of spinal
surgery but can be from 0.75% to 11.9%. A review of neurosurgical
spinal infections in Queen Elizabeth University Hospital, Glasgow from
1/1/15 to the 31/8/15 was performed.
Aim(s)/Objective(s): The Public Health England document
Surveillance of Surgical Infection in UK hospitals 2013/2014 quote a
spinal infection rate post surgery of 1.1%. This data was obtained from
surveillance of inpatients and readmissions in 30 hospitals in England
from April 2009 to 2014, a cohort of 33,053. As England is also in
the UK with a similar patient demographic, this was taken as an
Abstracts of FIS/HIS 2016 – Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24–S134 S112