Surgical Site Infection
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Surgical Site Infection

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Surgical site infection definition, Classification, risk factors,,Asepsis score, southampton scoring, colonization,bacteria causing SSI, Management of SSI

Surgical site infection definition, Classification, risk factors,,Asepsis score, southampton scoring, colonization,bacteria causing SSI, Management of SSI

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    Surgical Site Infection Surgical Site Infection Presentation Transcript

    • By Doctor Saleem
    • surgical site infections
      • 3 rd most common nosocomial infection
      • 14-16%
      • Most common nosocomial
      • infection among surgery
      • patients 38%
      • 2/3 incisional
      • 1/3 organ
    • Important Definitions
      • Colonization
        • Bacteria present in a wound with no signs or symptoms of systemic inflammation
        • Usually less than 10 5 cfu/mL
      • Contamination
        • Transient exposure of a wound to bacteria
        • Varying concentrations of bacteria possible
        • Time of exposure suggested to be < 6 hours
        • SSI prophylaxis best strategy
    • Contd;
      • Infection
        • Systemic and local signs of inflammation
        • Bacterial counts ≥ 10 5 cfu/mL
        • Purulent versus nonpurulent
      • Surgical wound infection is SSI
    • Criteria for defining SSIs
    •  
    •  
    •  
    • Further Classification
      • Etiology
      • a) Primary
      • The wound is the primary site of infection
      • b)Secondary
      • Infection arises following a complication that is not directly related to wound
    • Contd;
      • Time
      • a) Early
      • Infection presents within 30 days of procedure
      • b) Intermediate
      • Occurs between one and three months
      • c) Late
      • Presents more than three months after surgery
    • Contd;
      • Severity
      • a) Minor
      • Wound infection is described as minor when there is discharge without cellulitis or deep tissue destruction
      • b) major
      • When there is pus discharge with tissue breakdown , Partial or total dehiscence of the deep fascial layers of wound or if systemic illness is present.
    •  
    • Wound assesment
      • For surgical wound assesment several scoring systems are employed especially
      • a) Asepsis scoring
      • b) Southampton wound assessment scale
      • These enable surgical wound healing to be graded according to specific criteria, usually giving a numerical value, thus providing more objective assessment of wound.
    •  
    •  
    • Microbiology
    • Lactobacilli Streptococci Lactobacilli Enterobacteriaceae Aerobic + Anaerobic Microbial Populations
    • Pathogenesis Virulence Bacterial dose Impaired host resistance
    • Risk factors
      • Patient factors
      • Diabetes
      • Obesity
      • Nicotine use
      • Steroid use
      • Malnutrition
      • Hospital stay 
      • Nares colonization with S. aureus
      • Transfusion
      • Diabetes
        •  Controversial
        •  Patients underwent CABG
        • @ Increasing levels of HbA1c and SSI rates
        • @ Increased glucose levels (>200 mg/dL)
      • Nicotine use
        •  Delays primary wound healing
        •  Increase the risk of SSI
      • Steroid use
        •  Controversial
    •  
      • Malnutrition
        •  Theoretical arguments: increase the SSI risk
        •  Two randomized clinical trials: preoperative
        • “ nutritional therapy” did not reduce incisional and
        • organ/space SSI risk.
      • Prolonged preoperative hospital stay
      • Preoperative nares colonization with S. aureus
        • Mupirocin ointment: Controversial
      • Perioperative transfusion
        •  No scientific basis
    • Preop factors
      • Preoperative antiseptic showering
      • Preoperative hair removal
      • Patient skin preparation in the operating room
      • Preoperative hand/forearm antisepsis
      • Antimicrobial prophylaxis
      • Preoperative antiseptic showering
        •  Decreases skin microbial colony counts
        •  No evidance of benefit to reduce SSI rates
      • Preoperative hair removal
        •  Shaving:
        • @ immediately before the operation: SSI rates 3.1%
        • @ shaving within 24 hours preoperatively: 7.1%
        • @ having performed >24 hours: SSI rate > 20%.
        •  Depilatories:
        • @ lower SSI risk than shaving or clipping
        • @ hypersensitivity reactions
      • Patient skin preparation in the operating room
        •  Most common used: Alcohol solutions
        • Chlorhexidine gluconate
        • Iodophors
      • Preoperative hand/forearm antisepsis
    • Prophylactic antibiotics
      • Class 1 = Clean
      • Class 2 = Clean contaminated
      • Class 3 = Contaminated
      • Class 4 = Dirty infected
      Prophylactic antibiotics indicated Therapeutic antibiotics
    • Wound Classification Antibiotic PCN Allergy I 1 st generation Cephalosporin Vancomycin Clindamycin II-Biliary,GU, Upper Digestive 1 st generation Cephalosporin Vancomycin Clindamycin II-Distal Digestive 2 nd generation Cephalosporin Aztreonam and Clindamycin/Flagyl III/IV Generally Therapeutic
    • Once the incision is made, antibiotic delivery to the wound is impaired. Must give before incision! ABX
    •  
    • Operative characteristics
      • Operating room environment
      • Surgical attire and drapes
      • Asepsis and surgical technique
      • Operating room environment
        • Ventilation
          • @ Positive pressure with respect to corridors and
          • adjacent areas
        • Environmental surfaces
        • @ Rarely implicated as the sources of pathogens
        • important in the development of SSIs.
        • @ Important to perform routine cleaning of these surfaces
        •  Conventional sterilization of surgical instruments
        • @ Inadequate sterilization of surgical instruments has
        • resulted in SSI outbreaks
      • Surgical attire and drapes
        •  The use of barriers:
        • @ patient : minimize exposure to the skin, mucous
        • membranes, or hair of surgical team members
        • @ surgical team members : protect from exposure to
        • blood and bloodborne pathogens.
      • Asepsis and surgical technique
        •  Rigorous adherence to the principles of asepsis by all scrubbed personnel
        •  Excellent surgical technique: reduce the risk of SSI.
        •  Drains: increase incisional SSI risk.
    • Postoperative issues
      • Incision care
        •  The type of postoperative incision care
        • @ closed primarily: the incision is usually covered
        • with a sterile dressing for 24 to 48 hours.
        • @ left open to be closed later: the incision is packed
        • with a sterile dressing.
        • @ left open to heal by second intention: packed with
        • sterile moist gauze and covered with a sterile
        • dressing.
      • Treatment surgical site infection
      •  Efflux of purulent material and pus
      •  Fascia is intact:
      • debridement
      • Irrigated with N/S and
      • packed to its base with saline-moistened gauze
      •  Fascia separated: drainage or reoperation
      • Most SSIs: healing by secondary intention
      • Discharge planning
        •  The intent of discharge planning:
        • maintain integrity of the healing incision,
        • educate the patient about the signs and symptoms
        • of infection,
        • advise the patient about whom to contact to report
        • any problems.
    • Thankyou