Preventing Infection during Surgery is important. Standard Guidelines help team work on the same page. An update on various preventive strategy is discussed.

1. Update on prevention
of SSI
Dr Vaibhav Bagaria
Joint Replacement Surgeon
Sir HN Reliance Foundation Hospital
Mumbai

2. Why is Important?
• 2nd only to UTI in terms of Nosocomial
infections
• 2% of all hospitalised pts. ( 3 - 20%)
• Mortality - up to 3% pts die
• Morbidity
• Economic Burden

3. What am I doing here?

4. As a surgeon…
• It is a calling …
• We wear many hats!!!
• We are the face of both victory and defeat;
Sound of happiness and cries of despair!
• We Reap what we Sow ( Literally &
Figuratively)

5. Synopsis
• Definitions
• Risk Factors for developing SSI
• Microbiology
• Prevention of SSI General Measures
• Anti Microbial Prophylaxis
• Special Consideration regarding Staph
• Management of SSI

6. Definition
• Infection that occurs somewhere in the Op Field
following Surgical Intervention
• CDC considers SSI to include both Incisional and
Organ space SSI
• Incisional divided in Superficial and Deep
• Objective criteria developed by National Health
Safety network ( NHSN)
• Ultimately Surgeon’s judgement in equivocal cases

14. Surgical Wound Class

15. Key Points
• Development of SSI depends on patient -
related, procedure related and pathogen
related factors
• It can be altered by application of evidence
based prevention methods
• Causative Organism of SSI are predominantly
the flora present at Incisional Site.

16. Risk Factors
• Patient Factors: Co-morbid Illness, Colonization
with pathogenic bacteria, perioperative
hyperglycaemia and Tobacco use
• Procedural factor: Breaks in Sterile Technique,
Operating Room Ventilation and Traffic
• Proceduralist Factors: Surgical Technique,
improper application of skin antisepsis and
provider impairment

17. Patient Risk Factors

18. Procedural Factors

19. Proceduralist Factors

20. Prevention
• Practices to reduce bacterial inoculation into
Wound
• Practices to improve host containment of
introduced bacteria

21. Practices to reduce bacterial
inoculation into Wound
• Anti septic Use
• Sterile Attire
• Decolonization Strategies
• Proper hair removal

22. Skin & Bacteria

23. Power of 1
• Pathogenic Potential of a single bacterium to
produce wound infection, provided that it is
inoculated into a suitable niche.

25. Practices to improve host
containment of introduced bacteria
• Maintenance of Normothermia
• Minimising tissue hypoxia
• Glucose control
• Anti microbial prophylaxis

28. Antimicrobial Prophylaxis
• Tissue Concentration of drug above MIC for
common Flora
• Provide Right Drug: Target flora at the surgical
site, penetrate surgical incision site and
achieve minimum adverse event
• Provide Right Dose at Right Time
• Provide Right duration of drug

29. Prophylaxis

32. Newer delivery systems
• Antimicrobial washes
• Antibiotic cement
• Ab Coated sutures
• Intra operative Antibiotic sprays
• Antibiotic eluting Calcium Phosphate Brachytherapy
• Antibiotic Collagen Sponges

33. SSI Surveillance
• Standarized definitions
• Reduce variability in reported outcomes

37. Take Home Message

38. Thank You!!!
# Hustle @RFH