Risk factors for surgical site infection after minor dermatological surgery: a systematic review

Objective: Antibiotics can be prescribed as prophylaxis against surgical site infection (SSI) in dermatological surgery. In accordance with antibiotic stewardship, clinical evidence should inform judicious antibiotic prescribing. This review aimed to identify patient and procedure related risk factors for SSI following minor dermatological surgery. Data sources: MEDLINE, CINAHL, Informit and Scopus databases were searched for relevant literature on patient populations receiving minor surgery, where risk factors for SSI were explicitly stated. Study Selection: Studies involving major dermatological surgery were excluded. The preliminary search yielded 820 studies after removing duplicates. 210 abstracts were screened, and 42 full texts were assessed for eligibility. A total of 13 papers were included. Studies were appraised using the Newcastle-Ottawa Quality Assessment Scale. Data Extraction: An electronic data collection tool was constructed to extract information from the eligible studies, and distributed to participating authors. Data synthesis: Risk factors identified included age, sex, diabetes mellitus, chronic obstructive pulmonary disease (COPD), anti-hypertensive and corticosteroid use, smoking, surgery on the lower or upper extremities, excision of non-melanocytic skin cancers (NMSC), large skin excisions and complex surgical techniques. A maximum of two studies agreed on any one risk factor and there were insufficient studies for meta-analysis. Conclusions: Re-excision of skin cancer, below knee excisions and intra-operative haemorrhagic complications were predictive for infection in more than one study. More high-quality studies are required to accurately identify risk factors so they can be reliably used in clinical guidelines

Risk factors for surgical site infection after minor dermatological surgery

BACKGROUND: Surgical site infection (SSI) after dermatologic surgery is associated with poor outcomes including increased recovery time, poor cosmesis, and repeat visits to doctors. Prophylactic antibiotics are prescribed to reduce these adverse outcomes. Identifying risk factors for SSI will facilitate judicious antibiotic prophylaxis. OBJECTIVE: To identify risk factors for SSI after minor dermatologic surgery. METHODS: Individual patient data from four large randomized controlled trials were combined to increase statistical power. A total of 3,819 adult patients requiring minor skin procedures at a single facility were recruited over a 10-year period. The main outcome measure was SSI. MAIN RESULTS: A total of 298 infections occurred, resulting in an overall incidence of 7.8% (95% confidence interval [CI], 5.8–9.6), although the incidence varied across the four studies (P = .042). Significant risk factors identified were age (relative risk [RR], 1.01; 95% CI, 1.001–1.020; P = .008), excisions from the upper limbs (RR, 3.03; 95% CI, 1.76–5.22; P = .007) or lower limbs (RR, 3.99; 95% CI, 1.93–8.23; P = .009), and flap/two-layer procedures (RR, 3.23; 95% CI, 1.79–5.85; P = .008). Histology of the excised lesion was not a significant independent risk factor for infection. CONCLUSIONS: This study demonstrated that patients who were older, underwent complex excisions, or had excisions on an extremity were at higher risk of developing an SSI. An awareness of such risk factors will guide evidence-based and targeted antibiotic prophylaxis

Integrating social science into conservation planning

A growing body of literature has highlighted the value of social science for conservation, yet the diverse approaches of the social sciences are still inconsistently incorporated in conservation initiatives. Building greater capacity for social science integration in conservation requires frameworks and case studies that provide concrete guidance and specific examples. To address this need, we have developed a framework aimed at expanding the role for social science in formal conservation planning processes. Our framework illustrates multiple ways in which social science research can contribute to four stages of such processes: 1) defining the problem and project team; 2) defining goals; 3) identifying impact pathways and designing interventions; and 4) developing and evaluating indicators of success (or failure). We then present a timely case study of wolf reintroduction in Colorado, U.S.A., to demonstrate the opportunities, challenges, and complexities of applying our framework in practice

Alcoholic versus aqueous chlorhexidine for skin antisepsis: the AVALANCHE trial

Background: Preoperative skin antisepsisis routine practice. We compared alcoholic chlorhexidine with aqueous chlorhexidine for skin antisepsis to prevent surgical site infection after minor skin excisions in general practice. Methods: We conducted this prospective, multicentre, randomized controlled trial in 4 private general practices in North Queensland, Australia, from October2015 to August 2016. Consecutive adult patients presenting for minor skin excisions were randomly assigned to undergo preoperative skin antisepsis with 0.5% chlorhexidine in 70% ethanol(intervention) or 0.5% chlorhexidineaqueous solution (control). Our primary outcome was surgical site infection within 30 days of excision. We also measured the incidence of adverse reactions. Results: A total of 916 patients were included in the study: 454 underwent antisepsis with alcoholic chlorhexidine and 462 with aqueous chlorhexidine. Of these, 909 completed follow-up. In the intention-to-treat analysis of cases available at follow-up, there was no significant difference in the incidence of surgical site infection between the alcoholic chlorhexidine arm (5.8%, 95% confidence interval [CI] 3.6% to 7.9%) and the aqueous chlorhexidine arm (6.8%,95% CI 4.5% to 9.1%). The attributable risk reduction was 0.010 (95% CI –0.021to 0.042), the relative risk was 0.85 (95%CI 0.51 to 1.41), and the number needed to treat to benefit was 100. Per protocol and sensitivity analyses produced similar results. The incidence of adverse reactions was low, with no difference between groups (p = 0.6). Interpretation: There was no significant difference in efficacy between alcoholic and aqueous chlorhexidine for the prevention of surgical site infection after minor skin excisions in general practice. Trial registration: https://www.anzctr.org.au, no. ACTRN1261500104550