SURGICAL SITE INFECTIONSan updateworking protocol

1. SURGICAL SITE
INFECTIONS
an update
working protocol
Dr.T.V.Rao MD
22-02-2016 Dr.T.V.Rao MD 1

2. Beginning to know Microbes cause
Infections
• Louis Pasteur had just disproved the common belief that
microbes spontaneously came into existence on substrates
like meat broth. By proving instead that dust and air carried
the germs, he ushered in the golden age of microbiology and
anchored the growing “Germ Theory” of illness - that germs
caused and spread disease. In 1861, 26% of all Civil War
amputations resulted in death because of our inability to
control germs. At that point, amputation was actually the
best possible treatment for most battle wounds.
22-02-2016 Dr.T.V.Rao MD 2

3. In spite of many advances we are still with
many Surgical Site Infections
• It’s disappointing, then, that
the CDC currently predicts 1
of every 3 surgeries today in
the U.S. will result in an
infection. While fewer of
those will be fatal than the
Civil War surgeries, pain and
suffering are inevitable
(along with other
complications).
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4. Surgical Site Infection
• A surgical site infection is
an infection that occurs
after surgery in the part
of the body where the
surgery took place.
Surgical site infections
can sometimes be
superficial infections
involving the skin only.
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5. Every Surgical Procedure has an Impact
• Infections that occur in the
wound created by an
invasive surgical procedure
are generally referred to as
surgical site infections (SSIs).
SSIs are one of the most
important causes of
healthcare-associated
infections (HCAIs).
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6. We are Underestimating Surgical Site Infections
• SSIs accounted for 14% of these
infections and nearly 5% of
patients who had undergone a
surgical procedure were found
to have developed an SSI.
However, prevalence studies
tend to underestimate SSI
because many of these
infections occur after the patient
has been discharged from
hospital
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7. Identifying a Surgical site Infection a
priority
• SSIs are associated with
considerable morbidity and it
has been reported that over
one-third of postoperative
deaths are related, at least in
part, to SSI. However, it is
important to recognise that SSIs
can range from a relatively trivial
wound discharge with no other
complications to a life-
threatening condition
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8. Out Come of Surgical Site Infections
• Other clinical outcomes of SSIs
include poor scars that are
cosmetically unacceptable, such
as those that are spreading,
hypertrophic or keloid,
persistent pain and itching,
restriction of movement,
particularly when over joints,
and a significant impact on
emotional wellbeing
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9. Surgical Site Infection
•Other surgical site
infections are more
serious and can
involve tissues under
the skin, organs, or
implanted material.
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10. Symptoms include
•Redness and pain
around the area where
you had surgery
•Drainage of cloudy
fluid from your surgical
wound
•Fever
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11. After surgery
• If you do not see your providers
clean their hands, please ask them
to do so.
• Family and friends who visit you
should not touch the surgical
wound or dressings.
• Family and friends should clean
their hands with soap and water or
an alcohol-based hand rub before
and after visiting you. If you do not
see them clean their hands, ask
them to clean their hands.
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12. Caring the Wound and Hand Washing a
Priority
•Make sure you
understand how to
care for your wound
before you leave the
hospital.
•Always clean your
hands before and after
caring for your wound.
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13. Contacting Surgeon or Nurse is a
Priority
•If you have any
symptoms of an
infection, such as
redness and pain at
the surgery site,
drainage, or fever,
call your doctor
immediately22-02-2016 Dr.T.V.Rao MD 13

14. What are some of the things that hospitals are
doing to prevent SSIs
• To prevent SSIs, doctors, nurses, and other healthcare
providers should follow CDC infection prevention
guidelines including:
• Clean their hands and arms up to their elbows with an
antiseptic agent just before the surgery.
• Clean their hands with soap and water or an alcohol-
based hand rub before and after caring for each
patient.
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15. Trends to Control the Surgical Site Infections
• If indicated, remove some of your hair immediately before your
surgery using electric clippers if the hair is in the same area where the
procedure will occur.
• Wear special hair covers, masks, gowns, and gloves during surgery to
keep the surgery area clean.
• When indicated, give you antibiotics before your surgery starts. In
most cases, you should get antibiotics within 60 minutes before the
surgery starts and the antibiotics should be stopped within 24 hours
after surgery.
• Clean the skin at the site of your surgery with a special soap that kills
germs.
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16. Out Come of Surgical site Infections
• SSI can double the length of time a patient stays in hospital
and thereby increase the costs of health care. Additional
costs attributable to SSI have been reported depending on
the type of surgery and the severity of the infection. The
main additional costs are related to re-operation, extra
nursing care and interventions, and drug treatment costs.
The indirect costs, due to loss of productivity, patient
dissatisfaction and litigation, and reduced quality of life, have
been studied less extensively
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17. Who should monitor surgical site Infections in
developing countries
• Surgeons
• Microbiologist
• Theatre nurse
• Surveillance coordinator
• Infection control specialist
• Medical Superintendent
• Representative of the
Hospital Management for
timely funding
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18. Who should be responsible for taking
decisions on Surgical site Infections
• The appropriate treatment of
established SSIs requires careful
monitoring and communication
between the multidisciplinary
postoperative team (surgeons,
intensivists, microbiologists, and
the primary care team. If
patients are to be returned
home early then any SSI needs
to be recognised and treated
appropriately
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19. Decision Making in Surgical Site Infections
• Release of pus, debridement and
parenteral antibiotics, if
indicated, usually requires a
return to secondary care.
Extensive wound breakdown
may need specialist wound
management to reduce bacterial
burden in the open wound.
Wound bed preparation may be
required to encourage healing by
secondary intention or facilitate
secondary suture.
22-02-2016 Dr.T.V.Rao MD 19

20. Bring in Better Coordination with many
Professionals
• During the development
of the guideline, we need
expert advice from an
anaesthetist and
additional clinical
representation from a
surgeon and a theatre
nurse.
22-02-2016 Dr.T.V.Rao MD 20

21. Better care of the Environment is a priority
• Studies show that the opening and closing of doors
during surgery allow for the entry of bacteria-carrying
particles, which pose the risk of infection. While a
closed-door policy would be unfeasible for the
dynamic environment of today’s operating room, it is
undoubtable that decreasing traffic into and out of
the operating room during surgery would go a long
way toward reducing the risk of infection
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22. Other effective measures in Surgical site
Infections
Prophylaxis and management
of antibiotic-resistant bacteria
Management of the
operating theatre
environment and
environmental factors
Anaesthetic factors relating to
SSI.
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23. The science of Infection is changing every minute
Literature search strategy
• Initial scoping searches were
executed to identify relevant
guidelines (local, national
and international) produced
by other development
groups. The reference lists in
these guidelines were
checked against subsequent
searches to identify missing
evidence.
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24. Today We are Lucky to prevent
Infections
• One and a half centuries
later, we have hand
hygiene, antibiotics,
disinfectants, sterile
fields and sterile
instruments, heck - we
are performing brain
surgery with lasers
attached to robot arms!
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25. Other New Advances to Reduce Surgical
Site Infections
• Antibacterial sutures, which are
sutures coated with antibiotics,
were developed to help the
wound healing by reducing the
risk of surgical site infections.
Triclosan-coated sutures may be
one of the most effective
antimicrobial agents developed
and we are expected to greatly
contribute to decreasing SSIs
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26. New Advances to Reduce Surgical Site
Infections
• If combined with refined
and aseptic surgery
techniques and the proper
use of prophylactic
antibiotics. This might help
to decrease the length of
hospital stay for patients
undergoing gastric cancer
surgery.
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27. Reassure Patients with Surgical Site
Infections
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28. Many Peer Reviewed Studies Indicate that Hand
Washing still a Great priority
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29. 22-02-2016 Dr.T.V.Rao MD 29

30. Attention of Viewers
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Today I wish to be freelancer to the world to create interest in Medical, Clinical and Diagnostic
Microbiology with more emphasis on Infectious diseases and Hospital associated Infection wish to be
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•Mob +91 720411315422-02-2016 Dr.T.V.Rao MD 30

31. •Program Created by Dr.T.V.Rao MD for Benefit of
Medical and Paramedical Professionals in the
Developing World Created from World Wide
Resources
•Email
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22-02-2016 Dr.T.V.Rao MD 31