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acceptable standard for comparison. There is currently no active

surveillance of neurosurgical infections in Scotland.


A cohort of 457 patients was obtained. Discharge sum-

maries were scanned for mention of either a superficial skin infection,

or deep infection. Telepath, the microbiology laboratory system, was

also scanned to identify any organisms isolated from microbiological

samples during these episodes.


Interpretation of data showed the rate of infection to be 6.13%.

This is over five times the rate recorded in the Public Health England

Surveillance document.

Discussion and/or Conclusion(s):

This highlights the difficulties of

surgical site surveillance when there are no clear guidelines on

acceptable rates of infection.

Many factors will affect this rate such as patient characteristics,

co-morbidities, type of surgery, length of surgery, operating condi-

tions, aseptic techniques, skin prep and antibiotic prophylaxis. A full

range of quality improvement measures mapped to the NICE standards

for SSIs have been implemented.

ID: 4775

Unexplained differences in the risk of post-surgical infection in

Norway and England

Theresa Lamagni


, Hinta Meijerink


, Hanne Merete Eriksen



Suzanne Elgohari


, Pauline Harrington


, Oliver Kacelnik





Health England,


Department of Antibiotic Resistance and Infection

Prevention, Norwegian Institute for Public Health, Oslo, Norway;

European Programme for Intervention Epidemiology Training, European

Centre for Disease Prevention and Control, Stockholm, Sweden;


Department of Antibiotic Resistance and Infection Prevention,

Norwegian Institute for Public Health, Oslo, Norway


Marked differences in surgical site infection (SSI) rates in

different European countries have been observed.


To understand the degree towhich differences in

reported SSI rates in Norway and England are attributable to

methodological differences, a collaborative study was undertaken.


A comprehensive review of national surveillance methods,

participatory requirements and data quality was undertaken. Data

from September 2012 to January 2015 were pooled for categories of

surgery included in both programmes and analysed using logistic

regression (adjusted for sex, age, ASA score, wound class, post-

operative hospital days, operation duration).


Whilst both countries broadly followed CDC/ECDC protocols

for SSI surveillance, notable differences were identified in the

application of post-discharge case finding methods and case defini-

tions for superficial infection. Comparison of surveillance categories in

common to both countries

coronary artery bypass graft (CABG),

colon surgery, cholecystectomy and hip prosthesis

identified signi-

ficant differences in patient populations (ASA score, wound contam-

ination), length of stay, duration of surgery. Multivariable analysis

restricted to inpatient and readmission-detected deep incisional and

organ/space infections within 30 days of surgery identified signifi-

cantly higher rates of SSI in Norway than England for colon surgery

(aOR = 0.43, 95% CI 0.36

0.52), total hip (aOR = 0.21, 0.17

0.26) and

partial hip replacement (aOR = 0.11, 0.08

0.14). In contrast, SSI rates

were comparable for CABG and cholecystectomy.

Discussion and/or Conclusion(s):

Residual differences in SSI rates not

explained by patient or surgical risk factors were apparent for colon

and hip replacement surgery. Further cross-border investigation

should be undertaken to explore these differences and identify

opportunities for reducing SSI rates.

ID: 4878

Changes in the use of an ultra clean orthopaedic operating theatre

monitored during joint replacement surgery by settle plates

Andrew Thomas


, Christina Bradley


, Martyn Wilkinson



Adam Fraise




The Royal Orthopaedic Hospital,


Hospital Infection

Research Laboratory, University Hospital, Birmingham


The relationship between airborne contamination

and deep infection in joint replacements was demonstrated by

Charnley. Recent Registry data show that deep infection rates in joint

replacement surgery may be deteriorating. We used settle plates to

monitor air quality in a contemporary operating theatre during joint

replacement surgery.


Initially (first phase) we compared practice

to Charnley

s data. We then (second phase) had all staff using body

exhaust systems. We then (third phase) used data from laser imaging

airflow studies to predict optimum locations for the surgical instru-

ment trolleys. Our aim was to use settle plates to localise contamin-

ation on the instrument trays.


Operations were carried out in an Howorth Exflow ultra

clean enclosure. In phase 1 and phase 2 packs of 10 Petri dishes were

placed with five dishes on the instrument trolleys and five dishes

around the periphery of the operating theatre. Dishes were opened

when the incisionwas made and closed one hour later. In phase 3 eight

petri dishes were placed, four on each trolley in defined positions. Petri

dishes were incubated for 48 hours and the number of colonies



Phase 1 average growth was 0.2 colonies/plate/hour.

Second phase growth was 0.04 colonies/plate/hour. Third phase

growth was 0.31 colonies/plate/hour. The heaviest contamination

was at the opposite end of the instrument trolley next to the


Discussion and/or Conclusion(s):

We have demonstrated the stand-

ard which can be achieved in a contemporary operating theatre. The

study sets a standard for during surgery monitoring of ultra clean

air operating enclosures.

ID: 4930

A multifaceted intervention to decrease surgical site infections

following craniotomy

Miquel Pujol, Pilar Ciercoles, Evelyn Shaw, Dolors Somoza,

Carmen Cabellos, Ivan Pelegrin, Ana Hornero, Guillermo Cuervo,

Jordi Carratala, Andreu Gabarros.

Bellvitge University Hospital


Surveillance of surgical site infection (SSI) after cranio-

tomy was initiated in 2012 because of presumption of high infection

rates. About 200 procedures are performed yearly in our hospital. From

2012 to 2015 the yearly rate of SSI rate increased from 7.7% to 14.9%.

The aetiology was gram positive cocci and Propionibacterium acnes in

64% of cases and gram negative species, particularly Enterobacter spp

and P. aeruginosa in 36% of cases.


To describe a multifaceted intervention to reduce

the SSI in craniotomy and the impact of these interventions on SSI



Prospective surveillance of SSI in a 700-bed university

hospital in Barcelona, Spain. All patients admitted for elective or

urgent craniotomy from October 2012 to May 2016 were prospectively

followed for 30 days after surgery or 1 year if implant.


In November 2015 we implemented the following

interventions: (a) head wash inside the operating room with

povidone-iodine and saline (b) surgical antibiotic prophylaxis within


prior incision, (c) vancomycin powder (1 g) in subgaleal space

before skin closure, (d) sterile head wash at the end of surgery and (e)

coverture of surgical incision with a sterile absorbent wrap to prevent



From January to June 2016, 58 patients were followed; 50%

women, median age 52y (range: 20

80), 90% with implants. During

this period no surgical site infection was observed.

Discussion and/or Conclusion(s):

The introduction of a multifaceted

intervention of SSI prevention in craniotomies was safe and drastically

reduced the number of infections. However, a longer surveillance is

needed to verify these outstanding results.

Abstracts of FIS/HIS 2016

Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24