BackgroundMisclassification of wounds in the operating room (OR) can adversely affect surgical site infection (SSI) reporting and reimbursement. This study aimed to measure the effects of a curriculum on documentation of surgical wound classification (SWC) for operating room staff and surgeons.MethodsAccuracy of SWC was determined by comparing SWC documented by OR staff during the original operation to SWC determined by in-depth chart review. Patients 18 years or older undergoing inpatient surgical procedures were included. Two plan-do-act-study (PDSA) cycles were implemented over the course of 9 months. A total of 747 charts were reviewed. Accuracy of SWC documentation was retrospectively assessed across 248 randomly selected surgeries during a 5-week period prior to interventions and compared to 244 cases and 255 cases of post-intervention data from PDSA1 and PDSA2, respectively. Changes in SWC accuracy were assessed pre- and post-intervention using the kappa coefficient. A p-value for change in agreement was computed by comparing pre- and post-intervention kappa.ResultsInaccurate documentation of surgical wound class decreased significantly following curriculum implementation (kappa improved from 0.553 to 0.739 and 0.757; p = 0.001). Classification accuracy improved across all wound classes; however, class III and IV wounds were more frequently misclassified than class I and II wounds, both before and after the intervention.ConclusionImplementation of a multidisciplinary documentation curriculum resulted in a significant decrease in SWC documentation error. Improved accuracy of SWC reporting may facilitate a better assessment of SSI risk in a complex patient population.

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To determine whether use of absorbable antibiotic-imbued beads in chronic soft tissue wounds presents a viable therapeutic modality. Approach: Retrospective analysis of all cases utilizing calcium sulfate antibiotic beads was conducted. Cases comprised complex wound and breast reconstruction performed by the senior author (C.P.D.) over 4 years at the University of New Mexico Hospital. All-cause need for reoperation and reoperation for infection in the 90 days following bead-assisted surgery were compared to traditional surgical intervention in the 90-day period preceding bead-assisted surgery. Paired-samples t-test and corrected Cohen's d were calculated for outcome significance and effect size. Results: A total of 60 patients underwent 84 bead-assisted surgeries. There was a significant decrease in rate of reoperation following bead surgery (M = 0.32) compared with prebead surgery (M = 2.2), p < 0.001. Rate of reoperation for infection significantly decreased from 1.7 before bead surgery to 0.05 following bead surgery, p < 0.001. Results remained significant when stratified by complex wound or breast reconstruction, p < 0.01. Cohen's d ranged from 1.25 to 2.13, with probability of superiority between 80% and 93%. Innovation: Use of antibiotic-laden materials is well established in the orthopedic literature, but poorly characterized in soft tissue applications. Biofilms are increasingly implicated as a unifying pathologic foe underlying chronic wound infection and nonhealing. Antibiotic beads have demonstrated activity against biofilm in vitro. This study demonstrates diminished reoperative burden for these wounds following antibiotic bead surgery, possibly as a result of in vivo biofilm antagonism. Conclusion: Antibiotic bead-assisted surgery was associated with significantly decreased infectious and all-cause reoperations for chronic and infected wounds.

Discovered in swine manure relatively recently, Robsinoniella peoriensis is a gram-positive anaerobic bacilli that has been reported to cause human infections. Its antimicrobial susceptibility, epidemiology and overall pathogenicity are still not fully understood. We report a case of a hardware related soft tissue infection in the right femur caused by Robinsoneilla peoriensis following an open reduction internal fixation in a 67 year old immunocompetent woman. The patient was successfully treated with six weeks of ertapenem.

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