Sunday October 20, 2019

Surgical Infections More Common in Low-Income Countries, Study Finds

Overall, about one in 10 patients developed a surgical site infection. But in low-income countries, that rate rose to nearly one in four

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Infections at the site of surgery are the most common complications after operations.
Infections at the site of surgery are the most common complications after operations. Wikimedia Commons
  • Infections at the site of surgery are the most common complications after operations
  • Overall, about one in 10 patients developed a surgical site infection. But in low-income countries, that rate rose to nearly one in four
  • More than 1,500 health care providers took part in the research

Surgeries in low-income countries had higher rates of infections than those in higher-income countries, according to a new study published in The Lancet Infectious Diseases.

The authors said their report provided a starting point for making surgery safer.

Infections at the site of surgery are the most common complications after operations. These infections raise the cost of procedures that are already expensive. And they often make recovery longer and more painful.

Also Read: Tips That Will Help In Recovery From Surgery

The study looked at more than 12,000 gastrointestinal surgeries at 343 hospitals in 66 countries.

Marked difference

Overall, about one in 10 patients developed a surgical site infection. But in low-income countries, that rate rose to nearly one in four.

The study noted that hospitals in low-income countries gave patients more antibiotics than elsewhere, both before and after surgery. Wikimedia Commons
The study noted that hospitals in low-income countries gave patients more antibiotics than elsewhere, both before and after surgery. Wikimedia Commons

That’s after taking into account factors such as the patient’s health, the type of surgery and the condition being treated.

Other elements that could have been behind the difference included the kinds of facilities available in low-income countries, or how long it took to get patients to a hospital, said study co-author Ewen Harrison at the University of Edinburgh.

“If you’re in rural sub-Saharan Africa and you’re run over by a car, it may be a number of days before you can get to a hospital,” he said. “During that time, the infection can get into wounds.”

Drug resistance

Another component could have been the availability of effective antibiotics, Harrison said.

Antibiotics were nearly always given before surgery to prevent infection. But overall, about one in five surgical site infections were resistant to these antibiotics. The rate was higher in low-income countries — one in three — but the authors cautioned that they did not have enough data to draw firm conclusions.

Also Read: Study: Partial Dose of Yellow Fever Vaccine Provides Protection

Resistance generally develops faster the more antibiotics are used. The study noted that hospitals in low-income countries gave patients more antibiotics than elsewhere, both before and after surgery.

“That may be completely appropriate if the patients are needing the antibiotics,” Harrison said. “But that may also be an area where the unnecessary use of antibiotics could be reduced in order to reduce drug resistance.”

Antibiotics were nearly always given before surgery to prevent infection. Wikimedia Commons
Antibiotics were nearly always given before surgery to prevent infection. Wikimedia Commons

The authors’ next plan is to test different skin-cleaning techniques, antibiotic-impregnated stitches, and other simple, low-cost methods to reduce surgical site infections in low-income countries.

More than 1,500 health care providers took part in the research. Harrison said the study organizers “crowdsourced” their participants, using social media to recruit young surgeons-in-training around the world.

“They are really the driving force behind the change that we hope to happen,” he said.

Next Story

Growing Environmental Concerns over Concrete

Now, a quiet contest in constructing tall wooden buildings, from Amsterdam to Tokyo, underlines growing environmental concerns over concrete

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Environmental, Concrete, Countries
In this Nov. 15, 2016, file photo, engineer Eric McDonnell shows diagrams of skyscraper construction using cross-laminated timber in Portland, Oregon. City officials have approved a construction permit for the first all-wood high-rise in the nation. VOA

For more than a century, countries have raced to build the world’s tallest buildings with concrete and steel. Now, a quiet contest in constructing tall wooden buildings, from Amsterdam to Tokyo, underlines growing environmental concerns over concrete.

With rapid advances in engineered wood, and authorities relaxing building codes, wooden structures are sprouting across Europe, Canada, the United States, and in the Asia Pacific region.

At 73 meters (240 ft), Amsterdam’s Haut building is said to be the world’s tallest wooden residential tower.

Vancouver plans a 40-storey building it says will be the world’s tallest, a title also claimed by Sumitomo Forestry’s 350-meter (11,150 ft) skyscraper in Tokyo.

Environmental, Concrete, Countries
Visitors enter the Wood Hall building featuring its geometric patterns at downtown Tokyo, Aug. 22, 2017. VOA

“The interest is definitely being driven by environmental concerns — the amount of damage we’re doing with concrete is unbelievable,” said John Hardy, a sustainability expert in Bali, Indonesia.

“Bamboo and wood are carbon sequestering materials. So the other advantage of building with them is that you will look better to your children and grandchildren,” he said.

Construction of office towers, bridges, airports and highways is booming in developing nations across the world.

The manufacture of steel, concrete and brick accounts for about 16% of global fossil-fuel consumption — and up to 30% when transport and assembly of the materials is considered, according to the Yale School of Forestry & Environmental Studies.

Also Read- Top Sustainable Cities around The World

Concrete is also blamed for rampant sand mining, which has damaged the environment and hurt livelihoods in Southeast Asia.

In addition, an abundance of concrete has worsened urban flooding, and made cities hotter, environmentalists say.

In contrast, wood requires fewer fossil fuels to transport and assemble, and also effectively stores large amounts of carbon — trapped as the trees grew — for years, helping curb emissions, said Andy Buchanan, professor of timber design at the University of Canterbury in New Zealand.

More attractive 

Environmental, Concrete, Countries
For more than a century, countries have raced to build the world’s tallest buildings with concrete and steel. Pixabay

Each cubic meter of timber used in construction stores a carbon equivalent of over 900 kilograms (2,000 pounds) of CO2 emissions, meaning a reduction of 135 kg-360 kg of CO2 emissions per square meter of floor area, said Buchanan.

Innovations such as glue-laminated timber, laminated veneer lumber, and cross laminated timber — strips of wood glued together to make beams — are creating more uses for structural timber in residential and commercial projects, he said.

Structural timber is much lighter than concrete, cuts risks in earthquakes and can “create far more attractive interiors,” he said.

“As tall timber buildings become more popular, the perceived disadvantages — fire safety, durability and the supply chain — are being overcome with good design, excellent case study buildings, and technology for engineered-wood products.”

Also Read- 5 Grocery Shopping Tips to Avoid Unnecessary Stress

Examples are easy to find, from London’s nine-story residential Stadthaus to Melbourne’s 10-storey Forte apartment building.

A 54-meter (177 ft) wooden building in Vancouver that was thought to be the world’s tallest was quickly overtaken by an 85-meter (280 ft) tower in Norway.

Amsterdam’s 73-meter Haut will begin handing over its 55 apartments from 2021. Vancouver’s planned 40-story building will include 200 flats, while the 70-story Tokyo tower is slated to be completed by 2041.

“New technology, combined with accurate computer fabrication, now enables a wooden building to be assembled incredibly fast, like a giant piece of flat-packed furniture,” said Andrew Lawrence, a timber specialist at Arup, which designed Haut.

“Wood is ideally suited for lower rise buildings, but it is really exciting that engineers and architects worldwide are experimenting with the use of wood for taller structures,” he said.

Such buildings are particularly suited to cities, where buildings are constantly being adapted and refurbished for new uses, said Eleena Jamil, a Malaysian architect who has designed residential and commercial structures with bamboo and wood.

“Cities go through fast-paced changes. The advantage of using bamboo and timber is that they are easy to dismantle, reuse and adapt, compared to concrete,” she said.

But with excessive logging and deforestation already a problem in many Southeast Asian countries, it is important to balance demand for wood with “tighter regulations and more efficient management of forests,” she cautioned.

Wood first 

Under pressure to act on a material that produces 7% of the world’s carbon dioxide emissions, cement manufacturers also have been experimenting with lower-carbon concrete.

Authorities in several U.S. states are exploring the use of carbon-injected concrete that will use less cement while trapping carbon emissions.

Meanwhile, policy initiatives are hastening the move to wood from steel and concrete.

In New Zealand’s Christchurch, where authorities have encouraged a more environment-friendly approach after a 2011 earthquake that flattened much of the central business district, timber is a favored material.

The city, which creates about 600,000 square meters of new buildings each year, has the opportunity to store the equivalent of 30,000-200,000 tons of CO2 emissions per year if all new buildings were made of wood, said Buchanan.

Regions including British Columbia and Tasmania have adopted a “wood first” or “wood encouragement” policy that requires building designers to show that they have considered wood as an option.

Japan has a law to promote use of wood in public materials.

Such policies are “probably the most effective to encourage greater use of wood as a construction material, especially if supported through a carbon encouragement grant,” Buchanan said.

But the decision to use wood must be a considered one, said Amy Chow, a designer in Hong Kong who curated a show on wood, paper and bamboo.

“You can’t start off saying: let’s build this out of wood,” she said.

“It has to be the culmination of a process to determine what works best in that context, what is most sustainable, cost effective and efficient,” she said. (VOA)