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[Perioperative nosocomial infection preventive measures]
Ryoji Fukushima1, Tsuyoshi Inaba, Hisae Iinuma
1Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Abstract:
For the prevention of perioperative nosocomial infection, 1) topical mupirocin treatment, 2) tight perioperative glycemic control and 3) immunonutrition are described. A large, prospective, randomized trial showed that the nasal application of mupirocin may effectively reduce postoperative Staphylococcus aureus nosocomial infection in the subgroup of patients who had S. aureus in their nares. Tight glycemic control after surgery, especially in the early period after operation, may also be effective in decreasing postoperative infection. In septic ICU patients, strict glycemic control even reduces ICU and hospital mortality rates. Several specific nutritional substrates such as arginine, omega-3 fatty acids, glutamine, and RNA have been shown to modulate host immune function. Some enteral formulas enriched with such immunonutrients have been commercially available in the USA and in Europe and are now available in Japan. Recent meta-analyses of randomized, controlled trials have shown that the administration of these formulas to elective surgical patients results in a significant reduction in the risk of developing infectious complications by approximately 50% and shortens the overall hospital stay.
Insights
Topical mupirocin and strict glycemic control can prevent surgical site infections. Immunonutrition significantly reduces infectious complications and hospital stays in surgical patients.
Area of Science:
- Infectious Diseases
- Surgical Critical Care
- Nutritional Science
Context:
- Nosocomial infections pose a significant threat to surgical patients.
- Perioperative interventions are crucial for infection prevention.
- Current strategies include antimicrobial prophylaxis, glycemic control, and nutritional support.
Purpose:
- To review evidence-based strategies for preventing perioperative nosocomial infections.
- To highlight the efficacy of topical mupirocin, glycemic control, and immunonutrition.
- To discuss the impact of these interventions on patient outcomes.
Summary:
- Topical mupirocin nasal application can reduce Staphylococcus aureus infections in colonized patients.
- Tight perioperative glycemic control is associated with decreased postoperative infections and improved survival in ICU patients.
- Immunonutrition, using enteral formulas enriched with specific substrates, significantly reduces infectious complications and hospital stay in elective surgical patients.
Impact:
- These interventions offer effective methods for reducing the incidence and severity of nosocomial infections.
- Immunonutrition demonstrates a substantial risk reduction (approx. 50%) in infectious complications.
- Optimizing perioperative care through these strategies can lead to improved patient recovery and reduced healthcare costs.
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