Surgical Infections and Hand Hygiene in a Surgical Ward
European Journal of Preventive Medicine
Volume 6, Issue 6, November 2018, Pages: 76-81
Received: Oct. 24, 2018; Accepted: Nov. 19, 2018; Published: Dec. 10, 2018
Views 775      Downloads 109
Mihaela Leșe, General Surgery Department, Baia Mare Emergency County Hospital, Baia Mare, Romania
Raul Daniel Micu-Chis, General Surgery Department, Cluj-Napoca Municipal Clinical Hospital, Cluj-Napoca, Romania
Article Tools
Follow on us
The purpose of the study is to compare the community-acquired surgical infections with nosocomial infections caused by germs that are transmitted through the hands, in the General Surgery Department of the Baia Mare Emergency County Hospital, Romania. Materials and methods. There were selected all positive cultures with germs that are circulated through poor hygiene of hands from patients hospitalized during 2017. Samples were taken from surgical wound, peritoneal fluid, sputum, urine, stool, blood cultures and tegument. From the patient's electronic records were recorded: age, gender, DRG disease code (ICD 10), type of wound, administered antibiotics, postoperative progression, length of hospitalization and cost of day of hospitalization. Results. There were 201 (5.61%) patients with community-acquired infections and 71 (1.98%) with nosocomial infections with Staphylococcus aureus MSSA and MRSA, Enterococcus, Klebsiella pneumoniae, Enterobacter, Pseudomonas aeroginosa, Candida, Clostridium difficile and Streptococcus pyogenes. Community-acquired Staphylococcus aureus MRSA strains were more common in women, and the nosocomial ones in males. The most common deaths were caused by nosocomial infections with Candida (0.001), Klebsiella pneumoniae (p = 0.026) and Enterococcus (p = 0.001), and the highest cost / day of hospitalization was recorded in nosocomial infections with Staphylococcus aureus MRSA (p = 0.045), Enterococcus (p = 0.001) and Candida (p = 0.001). It was found resistance to betalactamic and vancomycin in the nosocomial strains of Staphylococcus aureus MRSA. Conclusions. Nosocomial infections with hands transmitted germs cause the worst surgical infections compared to community-acquired infections produced by the same types of germs.
Community-Acquired, Nosocomial, Infection, Hand Hygiene
To cite this article
Mihaela Leșe, Raul Daniel Micu-Chis, Surgical Infections and Hand Hygiene in a Surgical Ward, European Journal of Preventive Medicine. Vol. 6, No. 6, 2018, pp. 76-81. doi: 10.11648/j.ejpm.20180606.11
Copyright © 2018 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Aiello AE, Coulborn RM, Perez V, Larson EL, Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis, Am J Public Health. 2008 Aug; 98(8): 1372-81.
Magiorakos AP, Suetens C, Boyd L, Costa C, Cunney R, Drouvot V, Farrugia C, Fernandez- Maillo MM, Iversen BG, Leens E, Michael S, Moro ML, Reinhardt C, Serban R, Vatcheva- Dobrevska R, Wilson K, Heisbourg E, Maltezou HC, Strauss R, Borocz K, Dolinsek M, Dumpis U, Erne S, Gudlaugsson O, Heczko P, Hedlova D, Holt J, Joe L, Lyytikainen O, Riesenfeld-Orn I, Stefkovikova M, Valinteliene R, Voss A, Monnet DL, National hand hygiene campaigns in Europe, 2000-2009, Euro Surveill. 2009 Apr 30; 14(17).
Freeman MC, Stocks ME, Cumming O, Jeandron A, Higgins JP, Wolf J, Prüss-Ustün A, Bonjour S, Hunter PR, Fewtrell L, Curtis V, Hygiene and health: systematic review of handwashing practices worldwide and update of health effects, Trop Med Int Health. 2014 Aug; 19(8): 906-16.
Liu J, Yan Q, Luo F, Shang D, Wu D, Zhang H, Shang X, Kang X, Abdo M, Liu B, Ma Y, Xin Y, Acute cholecystitis associated with infection of Enterobacteriaceae from gut microbiota, Clin Microbiol Infect. 2015 Sep; 21(9): 851.e1-9.
Kvasnovsky CL, Leong LEX, Choo JM, Abell GCJ, Papagrigoriadis S, Bruce KD, Rogers GB, Clinical and symptom scores are significantly correlated with fecal microbiota features in patients with symptomatic uncomplicated diverticular disease: a pilot study, Eur J Gastroenterol Hepatol. 2018 Jan; 30(1): 107-112.
Guinane CM, Tadrous A, Fouhy F, Ryan CA, Dempsey EM, Murphy B, Andrews E, Cotter PD, Stanton C, Ross RP, Microbial composition of human appendices from patients following appendectomy, MBio. 2013 Jan 15; 4(1). pii: e00366-12.
Lobo LA, Benjamim CF, Oliveira AC, The interplay between microbiota and inflammation: lessons from peritonitis and sepsis, Clin Transl Immunology. 2016 Jul 15; 5(7): e90.
Vandegrift R, Bateman AC, Siemens KN, Nguyen M, Wilson HE, Green JL, Van Den Wymelenberg KG, Hickey RJ, Cleanliness in context: reconciling hygiene with a modern microbial perspective, Microbiome. 2017 Jul 14; 5(1): 76.
Pittet D, Hugonnet S, Harbarth S et al, Effectiveness of a hospital-wide programme to improve compliance with hand hygiene, Lancet. 2000; 356: 1307–1312.
Fox C, Wavra T, Drake DA, Mulligan D, Bennett YP, Nelson C, Kirkwood P, Jones L, Bader MK, Use of a patient hand hygiene protocol to reduce hospital-acquired infections and improve nurses' hand washing, Am J Crit Care, 2015 May; 24(3):
Dellinger EP, Surgical Infections: Introduction and Overview in Netter’s Infectious Diseases, Elsevier 2012, pp 238-9.
Aas JA, Paster BJ, Stokes LN, Olsen I, Dewhirst FE, Defining the normal bacterial flora of the oral cavity, J Clin Microbiol 43: 5721–5732.
Pei ZH et al, Bacterial biota in the human distal esophagus, Proc Natl Acad Sci USA 101: 4250– 4255.
Eckburg PB et al, Diversity of the human intestinal microbial flora, Science, 10 Jun 2005: Vol. 308, Issue 5728, pp. 1635-1638.
Shah PM, Edwards BL, Dietch ZC, Guidry CA, Davies SW, Hennessy SA, Duane TM, O'Neill PJ, Coimbra R, Cook CH, Askari R, Popovsky K, Sawyer RG, Do Polymicrobial Intra-Abdominal Infections Have Worse Outcomes than Monomicrobial Intra-Abdominal Infections?, Surg Infect (Larchmt). 2016 Feb; 17(1): 27-31.
Lipsky BA1, Tabak YP, Johannes RS, Vo L, Hyde L, Weigelt JA, Skin and soft tissue infections in hospitalised patients with diabetes: culture isolates and risk factors associated with mortality, length of stay and cost, Diabetologia. 2010 May; 53(5): 914-23.
Nguyen KV, Nguyen PT, Jones SL, Effectiveness of an alcohol-based hand hygiene programme in reducing nosocomial infections in the urology ward of Binh Dan Hospital, Vietnam, Trop Med Int Health, 2008; 13: 1297–1302.
Le TA, Dibley MJ, Vo VN, Archibald L, Jarvis WR, Sohn AH, Reduction in surgical site infections in neurosurgical patients associated with a bedside hand hygiene program in Vietnam, Infect Control Hosp Epidemiol, 2007 May; 28(5): 583-8.
Fierer N, Hamady M, Lauber CL, Knight R, The influence of sex, handedness, and washing on the diversity of hand surface bacteria, Proc Natl Acad Sci U S A, 2008 Nov 18; 105(46): 17994-9.
Joo EJ, Chung DR, Kim SH, Baek JY, Lee NY, Cho SY, Ha YE, Kang CI, Peck KR, Song JH, Emergence of Community-Genotype Methicillin-Resistant Staphylococcus aureus in Korean Hospitals: Clinical Characteristics of Nosocomial Infections by Community-Genotype Strain, Infect Chemother, 2017 Jun; 49(2): 109–116.
Solis-Hernandez P S, Vidales-Reyes M, Garza-Gonzalez E, Guajardo-Alvarez G, Chavez-Moreno S, et al, Hospital-Acquired Infections in Elderly Versus Younger Patients in an Acute Care Hospital, Int J Infect. 2016; 3(1): e32620.
Almeida GC1, dos Santos MM, Lima NG, Cidral TA, Melo MC, Lima KC, Prevalence and factors associated with wound colonization by Staphylococcus spp. and Staphylococcus aureus in hospitalized patients in inland northeastern Brazil: a cross-sectional study, BMC Infect Dis. 2014 Jun 13; 14: 328.
Crabtree TD1, Pelletier SJ, Antevil JL, Gleason TG, Pruett TL, Sawyer RG, Cohort study of fever and leukocytosis as diagnostic and prognostic indicators in infected surgical patients, World J Surg. 2001 Jun; 25(6): 739-44.
Moghadamyeghaneh Z, Hanna MH, Carmichael JC, Mills SD, Pigazzi A, Stamos MJ, Preoperative Leukocytosis in Colorectal Cancer Patients, J Am Coll Surg. 2015 Jul; 221(1): 207-14.
George S, Leasure AR, Horstmanshof D, Effectiveness of Decolonization With Chlorhexidine and Mupirocin in Reducing Surgical Site Infections: A Systematic Review, Dimens Crit Care Nurs, 2016 Jul-Aug; 35(4): 204-22.
Khan HA, Baig FK, Mehboob R, Nosocomial infections: epidemiology, prevention, control and surveillance, Asian Pac J Trop Biomed. 2017; 7(5): 478–82.
Dordel J, Kim C, Chung M, Pardos de la Gándara M, Holden MT, Parkhill J, et al, Novel determinants of antibiotic resistance: identification of mutated loci in highly methicillin-resistant subpopulations of methicillin-resistant Staphylococcus aureus, MBio. 2014; 5(2).
Hiramatsu K, Vancomycin-resistant Staphylococcus aureus: a new model of antibiotic resistance, Lancet Infect Dis, 2001 Oct; 1(3): 147-55.
Chakraborty A, Pal NK, Sarkar S, Gupta MS, Antibiotic resistance pattern of Enterococci isolates from nosocomial infections in a tertiary care hospital in Eastern India, J Nat Sci Biol Med, 2015 Jul-Dec; 6(2): 394–397.
Bhuiya M, Sarkar MKI, Sohag MH, Ali H, Roy CK, Akther L, Sarker AF, Enumerating Antibiotic Susceptibility Patterns of Pseudomonas aeruginosa Isolated from Different Sources in Dhaka City, Open Microbiol J, 2018 May 31; 12: 172-180.
Dupont H, Massias L, Jung B, Ammenouche N, Montravers P, Pharmacokinetic study of anidulafungin in ICU patients with intra-abdominal candidiasis, J Antimicrob Chemother, 2017 May 1; 72(5): 1429-1432.
Dupont H, Massias L, Jung B, Ammenouche N, Montravers P, Pharmacokinetic study of anidulafungin in ICU patients with intra-abdominal candidiasis, J Antimicrob Chemother, 2017 May 1;72(5):1429-1432.
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
Tel: (001)347-983-5186