Understanding and Preventing Surgical Site Infection following Surgery for Hand and Wrist Trauma.

了解和预防手和手腕创伤手术后的手术部位感染。

• 批准号: 2443416
• 金额: --
• 依托单位: University of Oxford
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2020
• 资助国家: 英国
• 起止时间: 2020 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-2443416
• 关键词: Understanding; Preventing; Surgical; Site; Infection

Injuries of the hand and wrist, collectively known as hand trauma, account for 1-in-4 of all injuries that present to A&E and nearly 1-in-5 of overall A&E attendances. Over 5 million injuries occur per year in the UK with nearly 250,000 hand and wrist trauma operations occurring each year. They occur in all ages but are most common in young working people and elderly people. These injuries require emergency assessment and treatment, sometimes including surgery, and specialist follow-up. Surgery has a risk of infection after the operation has been performed. Infection is the abnormal growth of bacteria in an area of the body that can lead to severe problems, sepsis and death. Infection following surgery at the site of an operation is a known complication after hand and wrist injury, and can happen to as many as 1 in 4 people. The impact of infection after hand and wrist surgery, including the effect on long-term hand and wrist function is not known. Infection is usually successfully treated with antibiotics and treatment at the site of the infection itself. One particular method to reduce the risk of infection is to use stitches that are coated in a substance that is toxic to bacteria - antimicrobial stitches. This could prevent bacteria growing on and around the wound stitches, reducing the likelihood of infection. There has been some research in other areas of the body that shows that these coated stitches may reduce infection, but they have not been tested in the hand and wrist. This study will characterise and describe infection rates after surgery for hand and wrist and will establish whether using antimicrobial stitches might reduce problems in terms of infection and any impact on function.I will investigate whether it is possible and practical to perform a clinical study to find out whether antimicrobial stitches can reduce the risk of infection after surgery for hand and wrist injury. This would need to be proved in a much larger study, where people are given antimicrobial stitches or normal stitches, by chance or like the toss of a coin (randomisation), without the knowledge of the surgeons or participants, performed at multiple hospital sites. The 'randomisation' aspect means that only the stitches are different between the study participants, so any difference in infection is probably down to the different stitches. In order to plan this, I will run a small-scale version of the study at two hospital sites to investigate how feasible this study is, in particular if there are any strengths or weaknesses that can be identified before a larger study is performed. The likely impact of this research will be a much better understanding of infection after hand and wrist trauma surgery and whether we can reduce infection with coated sutures. This will mean that people can be better informed by clinicians about infection risk before surgery is undertaken. It may also help us to reduce infection after hand and wrist trauma surgery and reduce the problems it causes for people. Lastly, understanding the use of coated stitches may help our fight against antibiotic resistance, which is an increasing problem worldwide.Research Skills TrainingI have developed a structured, bespoke research methods training programme that I will undertake during my fellowship:Systematic Review:I have authored 19 systematic reviews, including two Cochrane reviews to date. I have received training at the Cochrane UK Author Centre. This one of my areas of strength but I will seek to build on this by attending the Meta-analysis and Network Meta-analysis Courses at the University of Oxford.Epidemiology:I will also undertake training in epidemiology and big data analysis. This is a much newer area of research for me where I want to build my skills.Clinical Trials:I will receive training on designing and implementing clinical trials in surgery through both local practical training, and research methods training.

手和手腕的损伤，统称为手外伤，占所有A&E损伤的四分之一，占整体A&E就诊人数的近五分之一。在英国，每年发生超过500万起伤害，每年发生近25万起手部和手腕创伤手术。它们发生在所有年龄段，但最常见于年轻工作人员和老年人。这些损伤需要紧急评估和治疗，有时包括手术和专家随访。手术后有感染的风险。感染是身体某个部位细菌的异常生长，可导致严重问题、败血症和死亡。手术部位的手术后感染是手和手腕受伤后的已知并发症，并且可能发生在多达四分之一的人身上。手部和手腕手术后感染的影响，包括对长期手部和手腕功能的影响尚不清楚。感染通常可以通过抗生素和感染部位本身的治疗成功治疗。一个特别的方法，以减少感染的风险是使用缝线是在一种物质，是有毒的细菌-抗菌缝线涂层。这可以防止细菌在伤口缝线上和周围生长，减少感染的可能性。在身体的其他部位有一些研究表明，这些涂层缝线可能会减少感染，但它们尚未在手部和手腕上进行测试。本研究将描述手部和腕部手术后的感染率，并将确定使用抗菌缝线是否可以减少感染问题和对功能的任何影响，我将调查是否有可能和实际可行的临床研究，以了解抗菌缝线是否可以降低手部和腕部损伤手术后的感染风险。这需要在一项更大的研究中得到证明，在该研究中，人们被随机或像掷硬币一样给予抗菌缝线或正常缝线，而外科医生或参与者不知情，在多个医院进行。“随机化”方面意味着研究参与者之间只有缝线不同，因此感染的任何差异都可能归因于不同的缝线。为了计划这一点，我将在两家医院进行一项小规模的研究，以调查这项研究的可行性，特别是在进行更大规模的研究之前，是否可以确定任何优势或劣势。这项研究的可能影响将是更好地了解手部和腕部创伤手术后的感染，以及我们是否可以减少涂层缝线的感染。这将意味着人们可以在手术前更好地了解临床医生的感染风险。它还可以帮助我们减少手和手腕创伤手术后的感染，减少它给人们带来的问题。最后，了解涂层缝线的使用可能有助于我们对抗抗生素耐药性，这是一个日益严重的问题在世界范围内。研究技能培训我已经制定了一个结构化的，定制的研究方法培训计划，我将在我的奖学金：系统评价：我已经撰写了19篇系统评价，包括两篇科克伦综述至今。我在科克伦英国作者中心接受过培训。这是我的强项之一，但我将通过参加牛津大学的荟萃分析和网络荟萃分析课程来寻求建立这一点。流行病学：我还将接受流行病学和大数据分析方面的培训。这是一个新的研究领域，我想在那里建立我的技能。临床试验：我将通过当地实践培训和研究方法培训接受设计和实施手术临床试验的培训。