National survey of variations in practice in the prevention of surgical site infections in adult cardiac surgery, United Kingdom and Republic of Ireland

Background: Currently no national standards exist for the prevention of surgical site infection (SSI) in cardiac surgery. SSI rates range from 1% to 8% between centres. Aim: The aim of this study was to explore and characterize variation in approaches to SSI prevention in the UK and the Republic of Ireland (ROI). Methods: Cardiac surgery centres were surveyed using electronic web-based questionnaires to identify variation in SSI prevention at the level of both institution and consultant teams. Surveys were developed and undertaken through collaboration between the Cardiothoracic Interdisciplinary Research Network (CIRN), Public Health England (PHE) and the National Cardiac Benchmarking Collaborative (NCBC) to encompass routine pre-, intra- and postoperative practice. Findings: Nineteen of 38 centres who were approached provided data and included responses from 139 consultant teams. There was no missing data from those centres that responded. The results demonstrated substantial variation in over 40 aspects of SSI prevention. These included variation in SSI surveillance, reporting of SSI infection rates to external bodies, utilization of SSI risk prediction tools, and the use of interventions such as sternal support devices and gentamicin impregnated sponges. Conclusion: Measured variation in SSI prevention in cardiac centres across the UK and ROI is evidence of clinical uncertainty as to best practice, and has identified areas for quality improvement as well as knowledge gaps to be addressed by future research

Imaging shallow gas migration pathways in a mud‐volcano province using an autonomous underwater vehicle (Malta Plateau, Mediterranean Sea)

Data acquired by an autonomous underwater vehicle (AUV) towing a source (1600–3500 Hz) and a horizontal array of hydrophones have been analysed to image discrete, isolated or even a small cluster of scatterers within the sediment, to determine shallow migration paths of hydrocarbons in a mud volcano system of the Malta Plateau. An algorithm based on a semblance function was applied to the acoustic data to highlight scatterers rather than interface reflections. The resulting scatterer map, obtained along the AUV track, generated a pseudo‐three‐dimensional coverage of the study area, with a horizontal and vertical resolution of roughly 3–5 m and 5–10 m, respectively. This map was combined with high‐resolution bathymetric and backscattering seafloor maps obtained from previous explorations. This integrated dataset provides new evidence for the role of fault zones as a preferential path for gas/fluid migration and reveals the intermittent activity of seeping gas. The data show, in particular, that gas bubble slugs, i.e. discontinuous gas columns, rise through Plio‐Quaternary sediments along a complex system of conduits terminating at the surface into quiescent mud volcanoes. The gas flux is facilitated by the regional stress field that results in dilatant conditions on the mapped fault zones

National survey of variations in practice in the prevention of surgical site infections in adult cardiac surgery, United Kingdom and Republic of Ireland

BackgroundCurrently no national standards exist for the prevention of surgical site infection (SSI) in cardiac surgery. SSI rates range from 1% to 8% between centres.AimThe aim of this study was to explore and characterize variation in approaches to SSI prevention in the UK and the Republic of Ireland (ROI).MethodsCardiac surgery centres were surveyed using electronic web-based questionnaires to identify variation in SSI prevention at the level of both institution and consultant teams. Surveys were developed and undertaken through collaboration between the Cardiothoracic Interdisciplinary Research Network (CIRN), Public Health England (PHE) and the National Cardiac Benchmarking Collaborative (NCBC) to encompass routine pre-, intra- and postoperative practice.FindingsNineteen of 38 centres who were approached provided data and included responses from 139 consultant teams. There was no missing data from those centres that responded. The results demonstrated substantial variation in over 40 aspects of SSI prevention. These included variation in SSI surveillance, reporting of SSI infection rates to external bodies, utilization of SSI risk prediction tools, and the use of interventions such as sternal support devices and gentamicin impregnated sponges.ConclusionMeasured variation in SSI prevention in cardiac centres across the UK and ROI is evidence of clinical uncertainty as to best practice, and has identified areas for quality improvement as well as knowledge gaps to be addressed by future research.</div