5. Risk Factors for SSI: The
Patient
Age
Nutritional status
Diabetes
Nicotine use
Obesity
Coexistent infection
Colonization
Altered immune response
Long preoperative stay
How effectively can we control these risk factors?
6. Risk Factors for SSI: Pre- and
Intraoperative
Inappropriate use of antimicrobial prophylaxis
Infection at remote site not treated prior to surgery
Shaving the site vs. clipping
Long duration of surgery
Improper skin preparation
Improper surgical team hand antisepsis
Environment of the room (ventilation, sterilization)
Surgical attire and drapes
Surgical technique: hemostasis, sterile field
To a great extent, this is what we can
control!
9. HICPAC - SSI Prevention
Guidelines - 1999
No prior infections 15 air changes/hr in O.R.
Do not shave in advance Keep O.R. doors closed
Control glucose in patients with DM Use sterile instruments
Stop tobacco use Wear a mask
Shower with antiseptic soap Cover hair
Prep skin with approp. agent Wear sterile gloves
Surgeon’s nails short Gentle tissue handling
Surgeons scrub hands DPC for heavily contaminated
Exclude infected surgeons wounds
Give prophylactic antibiotics Closed suction drains
Pos pressure ventilation in O.R. Sterile dressing x 24-48 hr
10. Preoperative preparation
The pt should be assessed for factors that can be corrected in the
preoperative period before elective surgery. Open skin lesions should be
allowed to heal if possible,
Pt should be free of any bacterial infection of any kind
Should quit smoking if possible preferably one month before operation
Particular attention should be paid on the nutritional status of the pt obese pt
should loose wt as much as possible malnourished pt can benefit from even
brief courses of enteral nutritional supplement as little as 5 days may reduce
the risk of SSI.
CONTROLED OF DIABETES AND HYPERTENSION
Hyperglycemia decreases vit c uptake into cells this can be partially overcome
by supplements at 500-2000 mg /day
Vit A was helpful oral doses 25,000 u/day may overcome the inhibitory effect
of steroids which hinder wound healing
Should showed with antibacterial soap the night before the operation
12. Perioperative Glucose Control
1,000 cardiothoracic surgery patients
Diabetics and non-diabetics with hyperglycemia
Patients with
a blood sugar
> 300 mg/dL
during or
within 48
hours of
surgery had
more than 3X
the likelihood
of a wound
infection!
Latham R, et al. Infect Control Hosp Epidemiol. 2001.
13. Pre-operative shaving
Shaving the surgical site with a razor induces
small skin lacerations
– potential sites for infection
– disturbs hair follicles which are often colonized with S.
aureus
– Risk greatest when done the night before
– Patient education
It may be best NOT to have patient shave before they come
to the hospital.
18. Trauma related
infection
Hemorrhagic shock
Heavy wound
Contamination
CNS injury
Colon injury
Pts in shock are hypotensive and vasoconstricted and
tissue penetration of antibiotics may be decreased
, blood loss result in antibiotic loss
19. Trauma related
infection
Narrow spectrum for a defined
period of time (24 hrs)
1st or 2nd generation cephalosporin
(limited role in the therapy of
infections)
Higher dosed of antibiotics
Prolonged antibiotic increased the
risk of subsequent antibiotic
resistant organisms without benefit
to the patients
22. Consequences of Hypothermia
Perioperative patients
Adverse myocardial outcomes
1.5º C core temperature decrease triples the risk of
morbid myocardial events
Coagulopathy
impairs platelet function and coagulation cascade
Reduces drug metabolism
Thermal discomfort (patient satisfaction)
Surgical wound infection
thermoregulatory vasoconstriction
23. Temperature Control
– control - routine intra operative thermal care
(mean temp 34.7°C)
– treatment - active warming (mean temp on
arrival to recovery 36.6°C)
24. Supplemental Oxygen
Issues to Consider for
Perioperatively
Remarkably cheap, readily available
Little risk of atelectasis or impaired
pulmonary function
Reduce incidence and severity of
postoperative nausea
May improve alveolar phagocytosis and
bacterial killing
Reduce surgical wound infection
25. New active device for
prevention of SSI
Surgical device manufacturers are
introducing new dual-action or active
platform devices
Antibacterial sutures (VICRYL plus
antibacterial )
Polyglactin suture coated with triclosan
Kerlix antimicrobial dressing
Acticoat with Silcryst Nanocrystals
