SURGICAL SITE INFECTIONS: --ME MacraeB.Cur 1et A III University of PretoriaStudent No: 29606218SandtonMediClinicOperating Theatre15 Novemb
INTRODUCTION:- Surgical site infection is infection at the site of the operation (Usually an incision) that is caused by the operation.-SSI’s are second most common type of adverse event occurring in hospitalised patients-Have shown to increase-Mortality-Re-admission Rate-Length of stay-Cost for patients who incur them
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.
CARE BUNDLES: n general, are groupings of best practice interventions with respect to a disease process, which individually improve care, but when applied together - 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 SSIresult in a substantially greater improvement in patient care.
RUN CHARTS: Improvement takes place over time. Run charts are graphs of data over time and are one of the single most important tools in performance improvement. Run charts have a variety of benefits;Help improvement teams formulate aims by depicting how well or poorly a process is performingHelp to determine when changes are truly improving by displaying a pattern of data that can be observed as changes are madeAs you work on improvement, they provide information about the value of particular changes
Surgical site infections
SURGICAL SITE INFECTIONS ME Macrae B.Cur 1et A III University of Pretoria Student No: 29606218 15 November 2011 Sandton MediClinic Operating TheatreME MA C R A E B . C U R 1 E T 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 componentsME MA C R A E B . C U R 1 E T 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 MA C R A E B . C U R 1 E T 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 SSIME MA C R A E B . C U R 1 E T A I I I
PREOPERATIVE PHASEME MA C R A E B . C U R 1 E T 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 DOSAME MA C R A E B . C U R 1 E T 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 MA C R A E B . C U R 1 E T A I I I
RUN CHARTS ON-TIME PROHYLACTIC ANTIBIOTIC ADMINISTRATION 100% Goal % OF PATIENTS 80% Hospital 60% Series 3 40% Series 2 20% 0% Jan-11 Feb-11 Mar-11 Apr-11 May-11ME MA C R A E B . C U R 1 E T 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, durationME MA C R A E B . C U R 1 E T A I I I
APPROPRIATE HAIR REMOVAL Appropriate Inappropriate No hair removal Clipping Depilatory use Razors X 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 hospitalME MA C R A E B . C U R 1 E T A I I I
INTRAOPERATIVE PHASEME MA C R A E B . C U R 1 E T 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 dressingME MA C R A E B . C U R 1 E T 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 patientsME MA C R A E B . C U R 1 E T A I I I X
POSTOPERATIVE PHASEME MA C R A E B . C U R 1 E T 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 gauzeME MA C R A E B . C U R 1 E T 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 HoursME MA C R A E B . C U R 1 E T A I I I
CONCLUSION ljhkjME MA C R A E B . C U R 1 E T 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.ME MA C R A E B . C U R 1 E T A I I I
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