Infection control practices and infectious complications in dermatological surgery

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Summary

The aim of this study was to assess infection control practices and their impact upon infectious complications in skin surgery conducted by private dermatologists. A prospective study was carried out by 73 volunteers belonging to the Surgical Group of the Société Française de Dermatologie over a period of three months. Data were collected for surgical procedures performed during this period, including the excision of all benign or malignant tumours, but excluding sebaceous cysts and pyodermas. A total of 3491 dermatological surgical procedures were included in the survey. Post-operative infections occurred in 67 patients (1.9%), with superficial suppuration accounting for 92.5% of surgical site infections. The incidence was higher in the excision group with a reconstructive procedure (4.3%) than in excisions alone (1.6%). Infection control precautions varied according to the site of procedure; multivariate analysis showed that haemorrhagic complications were an independent factor for infection in both types of surgical procedure. The male gender, immunosuppressive therapy and not wearing sterile gloves were independent factors for infections occurring following excisions with reconstruction. Not all of the procedures needed the use of a hospital theatre. It is clear that for excisions with a reconstructive procedure or for certain anatomical sites, such as the nose, there should be more emphasis upon infection control precautions. Further studies are needed to establish optimal guidelines for this kind of surgery.

Introduction

Dermatologists have expanded their practice to include surgical procedures in response to the development of cutaneous tumours related to ageing. Surgery performed by dermatologists on an outpatient basis under local anaesthesia is less costly than other more complex options and has become the treatment of choice for certain cutaneous malignancies.1, 2 It is unclear what resources are currently available for this and there is little information about the complications which could follow this kind of surgery. We conducted a prospective study in order to investigate this. Part of this study, dealing with the incidence of complications associated with dermatological surgery, has been published previously.3 The main objective of the current paper, was to assess infection control practices and any association with infectious complications in skin surgery, conducted by dermatologists in private as well as hospital settings.

Section snippets

Methods

A prospective study was carried out among 73 volunteers from 130 dermatologists belonging to the Surgical Group of the Société Française de Dermatologie from 1 December 2002 to 28 February 2003. Data were collected for all consecutive surgical procedures performed during this period, including excisions of benign or malignant tumours but excluding sebaceous cysts (because most of them are already infected). Each dermatologist confirmed in writing that he/she would include all consecutive

Results

A total of 3491 dermatological surgical procedures were performed during the three-month survey, from an average of 45 (range 29–70) patients recorded by each dermatologist. The age of the patients ranged from 13 to 91 years with a mean of 51.4 years. Patient characteristics are shown in Table I.

The surgical procedures were classified as follows: 87.9% of simple excisions with suture [1721 with an overall scar of <2 cm (49.3%) and 1350 with an overall scar >2 cm (38.7%)] and 12.1% of excisions

Discussion

Many dermatologists now offer surgery for tumour excision.1 However, there have been very few studies of the incidence of infections associated with dermatological surgery.4 In this study, we have shown that the infection rate for these procedures is 1.9%. This includes minor superficial suppuration requiring additional antibiotic treatment, accounting for 15 cases out of 3491, i.e. 0.4%. The incidence was higher for excisions with a reconstructive procedure. Infections following dermatological

Acknowledgements

The authors thank all the volunteers of the Surgical Group of the Société Française de Dermatologie for their participation.

References (18)

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