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Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
Prevention of Surgical Site Infection- SSI [compatibility mode]
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Prevention of Surgical Site Infection- SSI [compatibility mode]

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Infection Control Guidelines for Prevention of Surgical Site Infection- SSI …

Infection Control Guidelines for Prevention of Surgical Site Infection- SSI
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.

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  1. ١
  2. Healthcare Associated Infections Due to SSI 290,485 infections 8,205 deaths SSI 17% Other 22% PNEU 14% BSI 14% 250,205 infections 35,967 deaths UTI 33% 248,678 infections 30,655 deaths 561,667 infections 13,088 deaths Klevens RM, et al. Public Health Reports. 2007 BSI PNEU SSI UTI Bloodstream Infection Pneumonia Surgical Site Infection Urinary Tract Infection ٢
  3. Impact of SSI SSI are associated with: Increased length of stay by 7-10 days  Increased cost per episode of up to $30,000 30,  Increased readmission rate of up to 40% 40%  Up to ~ 10 times increased risk of death compared to surgical patients without SSI  77% attributable mortality 77%  $10 billion in annual US healthcare expenditure  ٣
  4. SSI is a Global Public Health Priority 2nd Global Patient Safety Challenge Clean surgery  Safe anesthesia  Safe operators  Measurement and quality assurance  ٤
  5. Surgical Site Classification • No inflammation • No involvement of pulmonary, GIT or GU systems • Primarily closed and when drain is involved it is closed drainage • Only blunt trauma are included in this category ٥
  6. Surgical Site Classification cont…… • Pulmonary, GIT or GU system involvement, but under controlled conditions • For example: biliary tract, appendix, vagina, and oropharynx • No break in the technique ٦
  7. Surgical Site Classification cont… • Fresh open injuries • Operation with major break in sterile technique • Spillage from GI tract • Entry into the genitourinary tract with infected urine • Entry into the biliary tract with infected bile • Non-purulent inflamed surgical site ٧
  8. Surgical Site Classification cont… • Old traumatic wounds with retained devitalized tissues, foreign body or fecal contamination • Surgical procedures involved bowl perforation • Surgical procedures involved pus drainage ٨
  9. Diagnosed when you see pus at the site Purulent drainage from the site or the drainage Positive culture from the fluid of the drainage The surgeon diagnose infection SS requires re-opening ٩
  10. Sources of pathogens Personnel From the skin Hands, hair, scalp, nose and mouth S. aureus Environment Coagulase-negative staphylococci Contaminated solutions, antiseptics From the pulmonary system or dressings , GIT or GUS Surfaces Normal flora e.g. E. coli, Air Enterococci, P. Ventilation system aeruginosa … Positive pressure ١٠
  11. Staphylococcus aureus Coagulase-negative staphylococci Enterobacter spp. Etiological Agent Pseudomonas aeruginosa Enterococci Escherichia coli ١١
  12. Risk Factors Surgical site classification Prolonged preoperative stay Preoperative shaving Length of the operation Surgical technique Abdominal drains ١٢
  13. SSI Prevention Patient • Co morbid conditions • Immune status • Colonization Pathogen • Degree of contamination • Virulence • Antimicrobial resistance Procedure • Duration • Preparation • Type and technique • Equipment sterilization • OR characteristics ١٣ • Introduction of foreign material
  14. Prevention of SSI Preoperative Measures Preoperative stay Host factors Preoperative shower Hair removal Preoperative antibiotics Postoperative Phase Changing Dressings Intraoperative Postoperative Cleansing Measures Topical Antimicrobial Preparation of the Agents for Wound incisional site Healing by Primary Surgical scrub Intention Barrier devices Dressings for Wound Masks, Caps,Gowns Healing by Secondary and drapes Intention Reduction of air-borne Antibiotic Treatment of contamination in the OR Surgical Site Infection Operative technique and Treatment Failure ١٤
  15. Risk Prevention  Patient Characteristics – – – – – – Diabetes Nicotine use Steroid Use Malnutrition Prolonged Hospital Stay PrePre-operative nares colonization with Staph aureus – Peri-operative Transfusions Peri- ١٥
  16. Risk Prevention  Operative Characteristics: Preoperative Issues – – – – – Preoperative antiseptic showering Preoperative hair removal Patient skin prep in the OR Preoperative hand/forearm antisepsis Management of infected or colonized surgical personnel – Antimicrobial prophylaxis ١٦
  17. Preoperative Preparation ١٧
  18. Risk Reduction: Antimicrobial PrePre-Operative Shower  Chlorhexidene Gluconate – Primary choice  Iodophor  Hexachlorophene ١٨
  19. Risk Prevention  Operative characteristics: Intra-operative issues Intra– Operating Room environment  Ventilation  Environmental surfaces  Microbial sampling – do not do routinely  Conventional sterilization of surgical instruments  Flash sterilization of surgical instruments – Surgical attire and drapes  Scrub suits  Masks  Surgical caps/hoods and shoe covers  Sterile gloves  Gowns and Drapes – Asepsis and surgical technique  Asepsis  Surgical technique ١٩
  20. Intraoperative - OR Environment  Ventilation – Positive pressure to corridors – A minimum of 20-25 air exchanges per 20hour – Filter air – Ceiling supply vents and exhaust near floor  Humidity – 30-60% 30-60%  Temp 68-73°F 68-73° ٢٠
  21. Dress Codes & Drapes  Gloves  Masks  Sterile Gowns – determine the level of impermeability needed per procedure  Shoe covers – not infection prevention for SSI but prevents blood contamination  Drapes – impervious! ٢١
  22. Cleaning, Disinfection & Sterilization  Environmental cleaning – EPA approved hospital disinfectant   Patient care equipment and instruments Sterilization – Sterilize all surgical instruments according to published guidelines – Perform flash sterilization only for patient care items that will be used immediately  Do not use flash sterilization for convenience or for inventory control  Biological monitoring for sterilizers – Rapid readouts – 48 hour test – Steris ٢٢
  23. Gloving Aspects of Hand Hygiene   Wear gloves when contact with blood or other potentially infectious materials, mucous membranes, & nonintact skin could occur. Change gloves during patient care if moving from a contaminated body site to a clean body site.  Remove gloves after caring for a patient. – Do not wear the same pair of gloves for the care of more than one patient, – Do not wash gloves between uses with different patients. ٢٣
  24. Sterile Technique      Adhere to principles of asepsis Assemble sterile equipment and solutions immediately prior to use. Handle tissues gently, maintain homeostasis, minimize devitalized tissues and foreign bodies and eradicate dead space at the surgical site Use delayed primary skin closure or an incision open to heal by secondary intention if the surgeon considers the surgical site to be heavily contaminated If drainage is necessary, use a closed suction drain. Place a drain through a separate incision distant from the operative incision. Remove the drain as soon as possible. ٢٤
  25. Risk Prevention  Postoperative Issues – Incision care  Protect with a sterile dressing for 24 to 48 hours postoperatively an incision that has been closed primarily.  Wash hands before and after dressing changes any contact with surgical site  When an incision dressing must be changed, use sterile technique. – Discharge planning  Educate the patient and family regarding proper incision care, symptoms of SSI, and ٢٥ the need to report those symptoms
  26. WHAT IS A BUNDLE? A bundle is a structured way of improving processes of care and patient outcomes. It is a small straightforward set of practices – generally three to five that when performed collectively, reliably and continuously, have been proven to improve patient outcome. ٢٦
  27. Surgical Site Infection Prevention Bundle The Bundle 1. If at all possible avoid hair removal; if hair removal is necessary, avoid the use of razors 2. Ensure prophylactic antibiotic was prescribed as per local antibiotic policy guideline, for the specific operation category & Ensure the antibiotic was been administered within 60 minutes prior to the operation. 3. Ensure the patient’s body temperature was normal throughout the operation (excludes cardiac patients). 4. Ensure the surgical scrub & preparation of incision site was done. 5. Ensure the patient’s blood glucose level was normal throughout the operation (diabetic patients only). ٢٧
  28. Surgical Site Infection Prevention Bundle –Standard Operating Procedure Statement Surgical site infections arise when the host’s defences are overwhelmed by micro-organisms that come from the patient, disseminated from staff in the operating theatre or from inadequately decontaminated instruments. Procedures undertaken in the ward pre and post operatively, and in the theatre perioperatively must be designed to negate, or minimise as far as is possible, the risk of surgical site infection. Objectives Objectives: 1.To optimise peri-operative care minimising the risk of surgical site infections. 2.To be able to demonstrate quality peri-operative care in OUR clinical area Requirement s Before the SSI prevention bundle is performed. Signed commitment from the clinical team: consultants; junior doctors, ward manager and nurse team to optimising SSI prevention care. The data required for this bundle should be collected and documented on every patient. Analysis of compliance can be through the analysis of data (if there is ongoing surveillance), or via a weekly analysis of a selection of patients’ peri-operative records Procedure For weekly analysis review of notes 1.Perform hand hygiene. 2.On each ward select notes from 7 patients who underwent operations. 3.Check to see if the appropriate bundle criteria were recorded in the patients’ notes. 4.Record findings on the SSI bundle prevention data collection sheet. After care Complete form. Give it to: ٢٨ Discuss and display the data when it has been returned.(Keep bundle forms for xx time).
  29. Date: Location: Observer: (See overleaf for qualifying information) Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 Patient 6 Patient 7 1.If at all possible avoid hair removal; if hair removal is necessary, avoid the use of razors $ Yes No N/A Yes No N/A Yes No N/A Yes No N/A Yes No N/A Yes No N/A Yes No N/A 1.Prophylactic antibiotics were prescribed as per the local antibiotic policy/SIGN guideline for the operation category. Yes No Yes No Yes No Yes No Yes No Yes No Yes No 1.The antibiotic was administered 60 minutes prior to the start of the operation. Yes No Yes No Yes No Yes No Yes No Yes No Yes No 1.The patient’s body temperature was normal (36-37C) throughout the operation. $$ Yes No N/A Yes No N/A Yes No N/A Yes No N/A Yes No N/A Yes No N/A Yes No N/A 1.If diabetic, the patient remained normoglycaemic during the operation. $$$ Yes No N/A Yes No N/A Yes No N/A Yes No N/A Yes No N/A Yes No N/A Yes No N/A 1.The surgical scrub & preparation of incision site were done Yes No N/A Yes No N/A Yes No N/A Yes No N/A Yes No N/A Yes No N/A Yes No ٢٩ N/A
  30. Summary Table of SSI Prevention Bundle Findings Comment (if required) Total number of patients’ case notes reviewed (should be 7) No. Total number of patients requiring hair removal that operation sites were clipped. Total number of patients who were given the right antibiotics Total number of given antibiotics within 60 minutes of the start of the operation. Total number of patients who were normothermic throughout the operation. Total number of diabetic patients who were normoglycaemic throughout the operation. All or None Table – Was SSI prevention Optimal Tick if achieved 100% of patients requiring hair removal, hair was clipped. 100% of patients were given the correct antibiotics 100% of patients were given antibiotics within 60 minutes of the operation 100% of patients were normothemic throughout the operation 100% of diabetic patients were normoglycaemic throughout the operation. ٣٠ 100% of OR staff don surgical scrub & well prepared the incision site.
  31. ٣١

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