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ME MACRAE B.CUR 1ET A I I I
SURGICAL SITE INFECTIONSME Macrae B.Cur 1et A III
University of Pretoria
Student No: 29606218
15 November 2011
Sandton MediClinic
Operating Theatre
ME MACRAE B.CUR 1ET A I I I
INTRODUCTION
Definition of Surgical Site Infections The incidence of SSI’s SSI nosocomial infection Economic costs of SSIs
Morbidity Mortality Re-admission Rate Length of stay Cost for patients
Evidence-based care components
ME MACRAE B.CUR 1ET A I I I
IMPACT
Despite the best efforts of healthcare facilities to maintain safe surgical environments, surgical site infections result in up to $10 billion in treatment costs every year in the U.S. alone
780,000 out of 30 million surgical procedures performed annually in the U.S. result in SSI.1
In the United Kingdom, the estimated direct costs for a patient who has developed a surgical site infection are between €2,265 and €2,518.2
According to a study in the Netherlands, SSIs result in 5.8 to 17 extra days of hospitalization.3
In France, approximately 11% of surgical patients acquire a surgical site infection.
ME MACRAE B.CUR 1ET A I I I
CARE BUNDLES
A review of the medical literature shows that the following care components reduce the incidence of SSI: Day of Surgery Admission Appropriate use of Antibiotics Appropriate hair removal Maintenance of post-operative glucose control (Major cardiac
surgical patients) Post-operative normothermia (All open abdominal surgery)
The components, if implemented reliably, drastically reduce the incidence of SSI and virtually eliminate instances of preventable SSI
ME MACRAE B.CUR 1ET A I I I
PREOPERATIVE PHASE
ME MACRAE B.CUR 1ET A I I I
DAY OF SURGERY ADMISSION (DOSA) DOSA – Obvious means of reducing preoperative hospital
stay Guidelines for Prevention of SSI recommends this Category II – Supported by suggestive clinical or
epidemiological studies Encouraged to practice DOSA where possible Document reasons for not practicing DOSA
ME MACRAE B.CUR 1ET A I I I
PREOPERATIVE ANTIBIOTIC PROPHYLAXIS Purpose is to reduce the impact of intraoperative microbial
contamination of a surgical site to a level that will not result in infection
Antibiotics Selection Consistent with national guidelines Special cases: Allergy, prolonged use
Timely Administration Within one hour prior to surgery (Vancomycin or Fluoroquinolones: 2 Hours) Make sure all antibiotic is infused prior to inflation of cuff
Dosage At least a full therapeutic dose Upper ranges for large patients and/or long operations Repeat doses for long operations (>4 Hours)
ME MACRAE B.CUR 1ET A I I I
RUN CHARTS
Jan-11 Feb-11 Mar-11 Apr-11 May-110%
20%
40%
60%
80%
100%
Hospital
Goal
ON-TIME PROHYLACTIC ANTIBIOTIC ADMINISTRATION
Series 3Series 2
% O
F P
ATIE
NTS
ME MACRAE B.CUR 1ET A I I I
PREOPERATIVE ANTIBIOTIC PROPHYLAXIS Timely Discontinuation
Confirmed efficacy of > 12 hours Efficacy of a single dose Shorter course has been as effective as the longer course No need to continue coverage beyond 24 Hours even with tubes and
drains postoperatively Lack of evidence preventing SSI’s if given after the end of the
operation Increased use promotes antibiotic resistance
Antibiotic Use : selection, dosage, timing, duration
ME MACRAE B.CUR 1ET A I I I
APPROPRIATE HAIR REMOVAL
Influence of shaving on SSI Ensure adequate supply of clippers and train staff in proper use Use Reminders Educate patients not to self-shave preoperatively Remove all razors from the entire hospital
Appropriate Inappropriate
No hair removal Razors
Clipping
Depilatory use X
ME MACRAE B.CUR 1ET A I I I
INTRAOPERATIVE PHASE
ME MACRAE B.CUR 1ET A I I I
INTRAOPERATIVE PHASE
Hand Decontamination Incise Drapes
Do not use non-iodophor-impregnated drapes routinely
Use of sterile gown and gloves Antiseptic Skin Preparation
Prepare the skin at the surgical site immediately before incision Use an antiseptic (Aqueous or alcohol based) Preparation: povidone-iodine or chlorohexidine most suitable
Diathermy Do not use diathermy for surgical incision to reduce the risk
Wound dressings Cover surgical incisions with an appropriate interactive dressing
ME MACRAE B.CUR 1ET A I I I
PERIOPERATIVE NORMOTHERMIA
Hypothermia reduces tissue oxygen tension by vasoconstriction
Hypothermia reduces leukocyte superoxide production Hypothermia increases bleeding and transfusion
requirement Hypothermia increases duration of hospital stay even in
uninfected patients
X
ME MACRAE B.CUR 1ET A I I I
POSTOPERATIVE PHASE
ME MACRAE B.CUR 1ET A I I I
DRESSING FOR WOUND HEALING Changing Dressings
Use an aseptic non-touch technique for changing or removing surgical wound dressing
Post-Operative Cleansing Sterile saline for wound cleansing up to 48 Hours after surgery Advise patients they can shower safely after 48 Hours
Wounds healing by primary intention Do not use topical antimicrobial agents to reduce risk of SSI
Dressings for wound healing by secondary intention Refer to tissue viability nurse for advice on appropriate dressings for the
management of surgical wounds that are healing by secondary intention Do not use Eusol and gauze
ME MACRAE B.CUR 1ET A I I I
POST OPERATIVE SERUM GLUCOSE DETERMINATION Hyperglycemia or and risk of SSI No increased risk
Elevated HgbA1C Preoperative hyperglycemia
Increased Risk Diagnosed Diabetes Undiagnosed Diabetes Post-operative glucose > 200mg% within 48 Hours
ME MACRAE B.CUR 1ET A I I I
CONCLUSION
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ME MACRAE B.CUR 1ET A I I I
REFERENCES
Cook, R. “Hospitals learn simple, cheap steps can prevent infections,” San Francisco Chronicle, May 18,
2004; F1.
Coello R, Glenister H, Fereres J, Bartlett C, Leigh D, Sedgwick J, et al. The cost of infection in surgical
patients: a case–control study. J Hosp Infect 1993; 24(4):239–50., and Plowman R, Graves N, Griffin MA,
Roberts JA, Swan AV, Cookson, B, et al. The rate and cost of hospital–acquired infections occurring in
patients admitted to selected specialties of a district general hospital in England and the national burden
imposed. J Hosp Infect 2001; 47(3):198–209.
Geubbels EL, Mintjes–de Groot AJ, Van den Berg JM, de Boer AS. An operating surveillance system of
surgical site infections in the Netherlands: results of the PREZIES national surveillance network.
Prevenzxztie van Ziekenhuis infecties door Surveillance. Infect Control Hosp Epidemiol 2000; 21 (5): 107.
Source: Prevalence of nosocomial infections in France; results of the nationwide survey in 1996. Journal of
Hospital Infection. 2000; 46:186–193
http://www.ncbi.nlm.nih.gov/pubmed/9527963
Safer Systems – Saving Lives Preventing Surgical Site Infection – Version 4
http://www.health.vic.gov.au/sssl/downloads/prev_surgical.pdf Copyright State of Victoria, Department of
Human Services, 2005.
