Incidences and Risk Factors for Surgical Site Infections in Koutiala, Mali

Purpose: This paper aims to assess the incidences and risk factors for surgical site (ISO) infections in the general surgery department of the Koutiala District Hospital. Patients and Methods: This was a prospective and descriptive study from August 1, 2017 to October 31, 2020 involving all patients who underwent laparotomy in the general surgery department of the Koutiala District Hospital. Patients who were not operated on and who did not have a laparotomy were not included. Age, sex, frequency, patient history, National Nosocomial Infections Surveillance (NNIS) index, time to occur, bacteriological test results and course of infection were analyzed. Results: Fifty patients were registered. The average age was 34.2 ± 21.2 years old. Eleven patients were 60 years old or older. The hospital incidence rate was 4.3% and the community incidence rate was 6.1 cases per 100,000 population. The concept of smoking was noted in 15 patients. Patients were operated on in emergency 84% of cases. Peritonitis was the most common initial lesion with 32% of cases. Our patients had an NNIS index greater than 0 in 84% of cases. The time to develop infection from the surgical site was less than 3 days in 8 patients (16% of cases). Depending on the depth of the infection, it was superficial (cutaneous) in 39 patients (78%) and deep (subcutaneous and organic) in 11 patients (22%). Escherichia coli was the most common germ with 72% followed by staphylococcus aureus at 24%. We noted 22% morbidity. The median length of hospitalization was 9 ± 2.2 days. Conclusion: ISO is common in our service. Prevention and mastery require knowledge of risk factors.

Risk Factors for Surgical Site Infections in Patients Operated at the University Clinic of Traumatology-Orthopedics and Restorative Surgery of the National Hospital and University Center Hubert Koutoukou Maga in Cotonou

Background: Operative site infections (ISO) are typically nosocomial. According to the WHO the incidence of ISO varies from 0.5% to 15% and exceeds 25% in developing countries. They result from the combined action of several factors and represent a concern for public health. To study the contributing factors of surgical site infections in patients operated at the University Clinic of Orthopedic Traumatology of CNHU-HKM of Cotonou. Method: This was an analytical cross-sectional study that involved 35 operated patients and ten nurses. Were included in our study: 1) All patients, without distinction of sex or age, having been operated on in the university clinic of orthopedic traumatology, during the survey period;2) Patients hospitalized for post-operative care during the survey period;3) The nursing staff on duty during our study period. The usual statistical measures were used according to the type of variables: means, standard deviations, percentages. Data analysis first involved calculating percentages for the qualitative variables and means followed by their standard deviations for the quantitative variables. Next, the Pearson Chi-square test was used to test the association between the dependent variable and the independent variables of interest. The significance level is set at p Results: The prevalence of surgical site infections was 28.58%. The main factors contributing to the occurrence of SSIs that were found were the patient’s level of education (p = 0.003) and the reuse of bandages used for dressing (p = 0.004). Other potential factors such as the economic status of the patient, the poor quality of technical dressings, and the preoperative stay were also highlighted. Conclusion: Surgical site infections remain a global concern. Risk factors were found on both the patient and nurse sides. It is urgent to address these various factors to minimize the occurrence of surgical site infections.

Surgical Site Infection (SSI) in the National Referral General Hospital of Ndjamena (Chad): Survey about Risk Factors

The risk to develop an infection after surgery depends on several factors. Those factors may be interdependent or not, depending on the nature of the surgery and the general condition of the patient. The aim of the present study was to identify the factors involved in the occurrence of the Surgical Site Infections (SSI) in the National referral general hospital of N’djamena (Chad). We first realized an interview in the emergency services and in the general surgery of the hospital. The information collected allowed us to draw up survey sheets. An investigation was then conducted on 152 patients who had surgery and were hospitalized during the study period. The frequency of the SSI was 33.6% (51/152). The main risk factors that we identified were the duration of hospitalization, the category of the hospitalization room, the urgent aspect of the surgical intervention, the patient’s nutritional status and the associated diseases with diabetes, which was present in 52.38% (11/21) of cases of associated pathologies. Analysis of the antibiotic prophylaxis administered to patients showed that ciprofloxacin was more effective in SSI prevention. Indeed, this antibiotic showed the fewest cases of infection with only 1.9% of patients having developed SSI. Our results show a very high frequency of SSI at the National referral general hospital of N’djamena. Poor hospital practices and factors associated to patients seem to be the most factors implicated in the SSI.

Evaluation of Maintenance Strategies Based on Leakage Risk Assessment on Side Impervious Walls at Coastal Landfill Sites

Asset management is a strategic decision-making aspect of social infra-structure that ensures safety by predicting long-term conditions and maximizing effectiveness under budgetary constraints. Predicting the deterioration of impervious walls is essential in the asset management of coastal landfill sites, particularly in the design of their maintenance and repair strategy. In this paper, a quantitative evaluation of the leakage of toxic substances in coastal landfill sites where deterioration of side impervious walls has decreased the water interception performance is reported. In addition, risk evaluation based on the asset management of the leakage is applied to determine an appropriate repair method. The strategy of repairing the walls when the concentration of the toxic substances leaking into the sea area exceeds the closure and abandonment of coastal landfill sites is demonstrated to be superior. Moreover, the strategy of repairing only the seaside side impervious wall is shown to be cost-effective.

Seismic Site Specific Study for Seismic Microzonation: A Way Forward for Risk Resiliency of Vital Infrastructure in Sikkim, India

Seismic Microzonation comprising study of site specific seismic Microtremor (H/V ratio) is deployed to generate seismological parameters (Peak Frequency, Peak Amplification, Site Vulnerability Index) that may help estimate requisite factors for sound building design codes that can be used to construct risk resilient infrastructures. In this paper the site of Pakyong, Sikkim, India has been investigated by dividing it into three differed zones (Zone 1, Zone II, Zone III). The study area is associated with site amplification factor varying from 1.47 to 11.49 with corresponding frequency variations from 0.5 Hz - 12.5 Hz in which site vulnerability index found varied from 0.2 to 220.6. The anomalous subsurface formation with its high amplification corresponds to the centre of the Pakyong sites having conspicuous trend in NW-SE direction suggesting the existence of geological formations of Chlorite, Phyllite with intercalations of Quartzite beneath the centre of Pakyong site. The risk associated with vulnerability index for different zones maintains its variability as Zone I > Zone II > Zone III, indicating the low vulnerability index values are attributed to compact parts of the sub-surface materials with less amplifications whilst high vulnerability index of the site corresponds to relatively lower strength of the sub-surface materials and soft sediments underlying the Pakyong site which can be used for constructing risk resilient structure by enhancing the stiffness coefficient of the sub-surface by providing plausible engineering solutions for the purpose.

建筑施工现场安全风险分析及管理对策

建筑施工现场安全问题频发,对项目的整体安全构成威胁。从施工企业的角度出发,对施工现场管理中的共性问题进行剖析。研究发现,施工人员安全意识薄弱、设备运行状况不佳、异常气候下的特殊作业风险以及管理制度不完善等是导致安全风险问题的重要因素。基于此,提出制订安全施工方案、建立安全管理体系、明确安全生产责任,以及采用合理的技术手段等措施来确保施工安全顺利进行。

恩施州乡村旅游地农户返贫风险评估及其影响因素研究

有效预防返贫风险是后脱贫时代脱贫攻坚和乡村振兴战略有效衔接的关键.该研究将风险的概率纳入返贫风险评估体系,从发生概率和破坏程度两方面综合评估其返贫风险,系统反映返贫风险的可能性和破坏性,进而探究其影响因素.研究发现:1)农户各维度的返贫风险水平从高到低依次为个体风险、家庭风险、社会风险和自然风险,农户受家庭风险和个体风险影响较大,存在明显的内生性、个体化特征.2)依据风险的发生概率和破坏程度,返贫风险可分为“高概率-高破坏”型、“高概率-低破坏”型和“低概率-低破坏”型3种类型,其中,“高概率-高破坏”型风险包括非农就业能力和教育负担,返贫风险指数最高,对农户返贫的威胁最大.3)抚养人数和户主的文化程度等家庭特征是影响返贫风险的主要因素,乡村旅游扶贫开发模式不同导致农户的返贫风险存在显著差异.在返贫防治实践中,应因户施策,重点防治内生性返贫,同时要根据返贫风险发生概率及破坏程度的差异,制定合理的返贫风险预警机制及防治措施.

Risk Factors for Surgical Site Infection after Hip Arthroplasty: A Multicentric Study

The objective of this study is to answer three main questions: What is the risk of wound infection for patients undergoing hip arthroplasty? What are the main etiologicagents of surgical site infection (SSI)? What are the risk factors most associated with surgical site infection? Method: This was a multicentric, retrospective cohort study which analyzed data collected in five general hospitals in Belo Horizonte, Brazil, between the period of January 2009 and December 2013. The continuous parameters studied were age, length of hospital stay before surgery, duration of surgery, number of professionals at surgery and number of hospital admissions. Categorical variables were surgical wound classification (clean, clean contaminated, contaminated, dirty/infected), American Society of Anesthesiologists (ASA) score (I, II, III, IV, V), type of surgery (elective, emergency), general anesthesia (yes, no), prophylactic antibiotic (yes, no), trauma surgery (yes, no) and Nosocomial Infections Surveillance (NNIS) risk index (IRIC = 0, 1, 2, 3). Results: Estimated SSI risk was 3.2% (95% C.I. = 2.6% to 4.1%) and risk of osteomyelitis was 0.6% (95% C.I. = 0.4% to 1.1%). ASA score > 2, general anesthesia, length of hospital stay before surgery higher than four days, more than two professionals at surgical field and duration of surgery higher than five hours were risk factors for SSI after hip prosthesis (p < 0.05). The final multiple logistic regression analysis indicated that the modified NNIS risk was independently associated with surgical site infection after arthroplasty of hip. Conclusion: Despite the modified NNIS index being a risk factor for SSI, none of its independent variables was statistically significantly in the logistic model (p > 0.100). Each modified NNIS risk category increased the chance of a patient being infected by almost three times, when compared with the previous category (OR = 2.82;p = 0.011).

2型糖尿病合并感染患者肺炎克雷伯菌分布及预后影响因素分析

目的:探讨2型糖尿病(T2DM)合并感染患者肺炎克雷伯菌(KP)分布及预后影响因素分析。方法:选择226例T2DM患者为研究对象,根据是否合并KP感染分为未感染组(n=170)和感染组(n=56),分析T2DM患者感染的危险因素。收集T2DM合并感染患者KP标本,记录标本来源并进行菌种鉴定和药敏试验,并对所有菌株进行多位点序列(MLST)分型,记录预后情况。结果:基础疾病、抗生素使用、侵入性操作、血清白蛋白(ALB)、糖化血红蛋白(HbA1c)、空腹血糖(FPG)为影响T2DM发生感染的危险因素(均P<0.05)。T2DM合并感染患者体内分离56株肺炎克雷伯菌,肺炎克雷伯菌在痰液中的占比最高为44.62%,其次为尿液19.64%,血液中占比16.07%,脓液中占比12.5%,其他标本占比7.14%。56株KP总耐药率最高为氨苄西林,最低为亚胺培南,痰液标本中KP对头孢呋辛、头孢哌酮、庆大霉素耐药率高于非痰液标本,非痰液标本中KP对头孢他啶高于痰液标本(均P<0.05)。56株肺炎克雷伯菌MLST分型共发现42个ST型,ST-20型、36型、65型、347型、660型各2株,分别占3.57%,23型4株占7.14%,ST-17、25、29、35、37、45、86、189、208、211、218、322、355、412、490、519、557、595、726、776、1049、1092、1103、1319、1569、1916、2059、3014、3140、3536、4023、4194、4262、4412、4857型各1株,分别占1.78%,其他ST型7株占比12.5%。56例T2DM合并KP感染患者预后良好患者52例,预后不良患者4例,预后良好率为92.86%。结论:T2DM合并感染患者KP主要分布在痰液和尿液中,基础疾病、抗生素使用、侵入性操作、ALB、HbA1c、FPG是影响KP感染发生危险因素,T2DM合并KP感染患者根据药敏结果选择用药,有利于患者预后。

Heavy Metal Levels and Potential Ecological Risks Assessed at an Agroecosystem Site in Tropical Region

The concentrations and distribution of thirteen metals and metalloids were investigated in soils, sediments, and two biological matrices (the fish Clarias gariepisnis and the earthworm Pontoscolex corethrurus) from the CECOMAF agroecosystem, in Kinshasa, Democratic Republic of the Congo, in order to assess the impact of anthropogenic activities. The results revealed high concentrations of heavy metals, such as Cu, Zn, As, Cd, Pb, and Hg all above values recommended by sediment quality guidelines and their probable effect levels on biota. According to the calculated Enrichment Factor, soil and sediments ranked from moderately to heavily polluted by Cu, Zn, Cd, Pb and Hg. The Contamination Degree and other ecological risk indices indicated very high contamination and very high ecological risks posed by Cd and Hg, respectively. The Geoaccumulation Index indicated that current metal concentrations in the agroecosystem originated from anthropogenic activities, while the Spearman correlation matrix values indicated that Hg could originate from different sources and pathways than the other metals. It was concluded that metals from unchecked anthropogenic activities have negatively impacted agricultural activities and fish production at the CECOMAF agroecosystem. Action to reduce the contamination level and the ecological risks by remediating and preventing metal pollution in the CECOMAF agroecosystem site is recommended.

Incidence and Outcomes of Surgical Site Infections after Adult Cardiac Surgery: A Single-Center Experience

Background: Surgical site infections (SSIs) remain a challenging medical problem, especially in cardiac surgery patients. There is a lack of studies evaluating the rate of and outcomes of SSIs following cardiac surgeries in Saudi Arabia. Aims: This study aimed to determine the incidence of SSIs after adult cardiac surgeries that were done in Madinah Cardiac Center, Saudi Arabia. Further, to identify the outcomes and risk factors contributing to death among surgical site infection patients. Methods: This was a 6-year, single-center, retrospective cohort study that included 93 consecutive patients who underwent adult cardiac surgery between August 2016 and August 2022. All adult patients aged 18 years or older who had clinical evidence of postoperative surgical wound infection were included. Preoperative, operative, and postoperative data (early and late) were collected from medical records. Microbiological culture reports and clinical outcomes were also recorded. Results: The study revealed a 9.1% (93/1021) incidence rate of SSIs. Of the 93 patients with SSIs, 60 had superficial incisional infections and 33 had deep infections with incidence rates of 5.9% and 3.2%, respectively. In-hospital mortality due to SSI was recorded in 4 out of 93 patients with an incidence rate of 4.3%. There was a significant association between the in-hospital mortality and the type of SSIs (p = 0.014). All non-survivors had deep SSIs. The type of cardiac surgery also showed a significant association with the in-hospital mortality (p = 0.017). Furthermore, the median duration of antibiotic administration was significantly longer in the non-survivors than in the survivors (72.5 vs 17, respectively, p Conclusions: In conclusion, the incidence of surgical wound infections following cardiac surgery is not low (9.1%);of which 3.2% were deep infections. The in-hospital mortality rate after treatment of SSIs was fortunately low (4.3%), and all non-survivors had deep SSIs. The non- survivors showed a significantly longer duration of antibiotics administration than survivors. Combined CABG and valve procedures showed a higher mortality rate (75%) than the isolated procedures.

药物临床研究阶段申办者和生产场地变更研究六:临床研究阶段申办者和生产场地跨境变更的风险分析

目的:通过对临床研究阶段申办者、生产场地发生跨境变更时的风险变化进行分析,为申办者和生产场地的跨境变更管理提供参考。方法:基于申办者和生产场地不同组合情形的初始风险评价结果和采取风险管控措施后的风险再评价结果,比较分析不同组合情形之间发生变更时变更前后的“风险指数水平”变化。结果与结论:基于初始风险评价结果,有两种变更情形的风险指数水平在变更后较变更前降低;基于风险再评价结果,有四种变更情形的风险指数水平在变更后较变更前降低。

暴雨灾害下的建筑施工现场风险评价研究

为了准确判断施工现场在突降暴雨情况下的安全状态,采用贝叶斯最优最劣法(Bayesian Best Worst Method,BBWM)和云模型方法,提出暴雨灾害下的建筑施工现场风险评价模型,以确定施工现场在遭受暴雨灾害时的风险等级。该模型利用了压力状态响应模型(Pressure State Response,PSR)和灾害系统理论,在考虑致灾因子危险性、孕灾环境稳定性、承灾体脆弱性和减灾能力抵御性4方面的基础上,构建18个风险因素的施工现场风险评价指标体系,并以武汉市某施工现场为例进行验证。结果显示,施工现场的减灾能力抵御性处于最重要的地位,做好现场减灾应对措施对灾害有非常重要的帮助;案例项目的评价结果处于一般风险状态,与现场实际情况相符。

Risk Factor of Postoperative Lumbar Surgical Site Infection: A Literature Review

Nowadays there have been various advanced techniques to overcome disparate types of lumbar degenerative diseases. However, post-operation complications such as Surgical Site Infection (SSI) still give the surgeon with a big challenge. This article is going to study the risk factor that causes the lumbar SSI by reviewing all the articles that can be assessed through PubMed, websites of science and other internet data base. Numerous articles have stated different reported prevalence rates of 0.7% to 16% for surgical site infection. This article will document the most common and significant risk factors for SSI. At last, we suggest that there should be preoperative patient screening and postoperative internal environment maintenance, this will be the best way to reduce postoperative SSI rate or prevent SSI from happening.

考虑淹没区域危险度的溃坝洪灾避难场所选址评价

针对溃坝洪灾避难场所选址中对潜在淹没区域危险程度重视不足的问题,提出了一种新的溃坝洪灾避难场所选址评价模型。首先,在构建危险度评价指标体系的基础上,运用改进突变评价法对潜在淹没区域进行危险度评价和危险等级划分;其次,将避难场所与高级别危险区的距离作为选址评价指标,并考虑避难场所的灾害风险、位置规模、应急保障等条件,通过层次分析法确定权重,运用TOPSIS法对避难场所进行选址评价;最后,以我国陆浑水库下游13个潜在淹没区域和10个备选避难场所为例进行验证。结果表明:危险等级较高的潜在淹没区域中,白元镇为Ⅰ级危险区,彭婆镇、鸣皋镇、城关街道、龙门镇为Ⅱ级危险区,评价较优的备选避难场所能够满足重视高危险度潜在淹没区域的要求。

腹腔镜胆囊切除术后Trocar疝六例临床分析

目的分析腹腔镜胆囊切除(LC)术后Trocar疝(TSH)的发病特点及防治策略。方法回顾性分析解放军96601部队医院2007年1月至2022年9月择期行LC手术术后发生TSH患者的临床资料,LC术后随访1年。结果11500例LC患者术后发生TSH共6例,发病率为0.05%,其中体质指数(BMI)>28 kg/m2患者占83.3%,切口延长(取胆囊部位切口>1 cm)患者占100%,糖尿病患者占66.7%;TSH发病时间为术后5 d~16个月,5例发生在剑突下,1例发生在脐部。结论LC术后TSH是一种或多种因素共同作用的结果,提高对TSH的认识并改良手术方式,将有助于降低TSH的发病率,改善LC患者的整体预后。

典型钢铁冶炼场地重金属污染空间分布特征及风险评价

以上海某关停钢铁冶炼厂为研究对象,结合专业判断布点法与系统布点法布设83个土壤点位,采集表、中、深层共249个土壤样品,分析As、Pb、Cd、Ni、Hg、Cu这6种重金属的分布特征、污染状况、潜在生态风险及健康风险。结果表明,As、Pb出现部分样品超标,Cd、Pb为强变异,其他重金属变异程度中等;重金属平均含量在垂向上呈现自上而下逐渐降低的趋势,且最高值均分布在表层,累积区域主要为扒渣厂房、钢渣处理区和废钢配料间;地累积指数评价结果显示,Cd和Pb的污染相对较为严重,重污染及以上的样品比例分别为8.43%、3.61%。潜在生态风险评价结果显示,场地整体的生态风险较高,Cd为主要贡献因子,较强风险及以上的样品占比高达51.81%;人体健康风险评价结果显示,Pb、As和Cd可能对人体产生一定的健康风险,因此有必要开展土壤的风险管控或修复以保证场地的再开发利用。

老年股骨颈骨折患者髋关节置换术后手术部位感染的危险因素分析

目的 评估老年股骨颈骨折患者行髋关节置换术后手术部位感染的危险因素,为有效地预防老年股骨颈骨折术后手术部位感染提供参考依据。方法 选取漯河医学高等专科学校第二附属医院2018年1月-2023年3月收治的老年股骨颈骨折患者350例,均行髋关节置换手术治疗,根据术后手术部位感染情况分为感染组22例,未感染组328例;比较2组患者的一般情况、手术方式、手术时间、基础疾病,归纳老年股骨颈骨折患者术后手术部位感染的影响因素。结果 高龄(>80岁)、肥胖、低蛋白血症和糖尿病是老年髋部骨折患者术后感染的危险因素(P<0.05)。结论 高龄、肥胖、低蛋白血症和基础疾病是老年股骨颈骨折患者术后手术部位感染的危险因素,应加强相关监管;对于怀疑手术部位感染的患者,应积极送检病原菌培养,重视真菌及分枝杆菌可提高病原菌检出率。

吉林省智慧工地建设的风险评价研究

为防范与化解智慧工地建设存在的各种风险,避免酿成巨大损失,造成严重后果,推动吉林省智慧工地风险评价工作的专业化及标准化发展势在必行。归纳总结了6个一级指标与22个二级指标,建立了智慧工地建设风险评价指标体系。在权重计算的过程中引入三角模糊数,将改进层次分析法和反熵权法组合赋权,创建基于改进GRA-TOPSIS法的评价模型。运用此模型对三个实际项目进行评价,根据求得的相对接近度确定项目及指标的风险等级和排序,并对比传统TOPSIS法和熵权TOPSIS法的运算结果。最终通过雷达图分析项目潜在的风险程度与风险控制的薄弱环节。研究证明,改进GRA-TOPSIS法适用于风险评价,能准确有效地评价智慧工地建设的风险。

基于改进YOLOv5的井场作业风险智能识别与分类

为精确识别井场安全生产过程中存在的不规范行为,降低井场事故发生率,提出了一种改进YOLOv5井场作业风险智能分类识别方法。首先,使用labelimg工具标注出这些不规范的行为;其次,以YOLOv5为基础网络,通过在基础网络结构中替换损失函数和增加注意力机制模块来改善目标检测问题。用SIoU Loss损失函数替换CIoU Loss损失函数,对距离损失进行重新定义,有效减少了回归自由度,加速了网络收敛速度,提高了回归精度。通过增加注意力机制模块,网络能够对输入图像进行自主学习并关注其中的重要信息,以提升模型的鲁棒性和泛化能力。实验证明,改进的YOLOv5算法可以对井场作业中的不规范进行有效的分类和识别。与原有YOLOv5方法相比精度提高了3%,改进方法在保证正确率的前提下,具有较高的预测精度和较好的实时性,获得了较满意的效果。