Impact of lockdown for SARS-CoV-2 (COVID-19) on surgical site infection rates: a monocentric observational cohort study
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ORIGINAL ARTICLE
Impact of lockdown for SARS‑CoV‑2 (COVID‑19) on surgical site infection rates: a monocentric observational cohort study Pasquale Losurdo1 · Lucia Paiano1 · Natasa Samardzic1 · Paola Germani1 · Laura Bernardi1 · Massimo Borelli1 · Barbara Pozzetto1 · Nicolò de Manzini1 · Marina Bortul1 Received: 21 July 2020 / Accepted: 3 September 2020 © Italian Society of Surgery (SIC) 2020
Abstract Surgical site infections are the most common in-hospital acquired infections. The aim of this study and the primary endpoint is to evaluate how the measures to reduce the SARS-CoV-2 spreading affected the superficial and deep SSI rate. A total of 541 patients were included. Of those, 198 from March to April 2018, 220 from March till April 2019 and 123 in the COVID19 era from March to April 2020. The primary endpoint occurred in 39 over 541 patients. In COVID-19 era, we reported a lower rate of global SSIs (3.3% vs. 8.4%; p 0.035), few patients developed a superficial SSIs (0.8% vs. 3.4%; p 0.018) and none experienced deep SSIs (0% vs. 3.4%; p 0.025). Comparing the previous two “COVID-19-free” years, no significative differences were reported. At multivariate analysis, the measures to reduce the SARS-CoV-2 spread (OR 0.368; p 0.05) were independently associated with the reduction for total, superficial and deep SSIs. Moreover, the presence of drains (OR 4.99; p 0.009) and a Type III–IV of SWC (OR 1.8; p 0.001) demonstrated a worse effect regarding the primary endpoint. Furthermore, the presence of the drain was not associated with an increased risk of superficial and deep SSIs. In this study, we provided important insights into the superficial and deep SSIs risk assessment for patients who underwent surgery. Simple and easily viable precautions such as wearing surgical masks and the restriction of visitors emerged as promising tools for the reduction of SSIs risk. Keywords Surgical site infections · SARS-CoV-2 · COVID-19 · Italy lockdown
Background Surgical site infections (SSIs) are the most common in-hospital acquired infections, adding up to 46.4% of all infections, as reported by the CDC [1]. The first site of infection, in terms of timing, is the superficial incision [2]. We must not underestimate this problem because it has a significant impact on morbidity, mortality, length of hospital stay and overall costs [3]. There are many ways to reduce the rate of SSIs both peri- and intra-operatively. The optimization of the modifiable patient risk factors (e.g., smoking cessation, optimal glycemic control, bathing, screening for resistant bacteria) is the first step to pursue in the prevention of SSIs [1]. World Health Organization * Pasquale Losurdo [email protected] 1
Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
(WHO) introduces the “global guidelines for the prevention of SSI” [4, 5] where pre- and intraoperative measures are the use of antimicrobial prophylaxis, alcoholic Clorexidine for
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