This clinical audit assessed lower segment caesarean section procedures to evaluate the relationship between surgery duration and postoperative morbidity like hospital stay duration. It also assessed the effects of prophylactic antibiotics on postoperative surgical site infections, endometritis and urinary tract infections. The average operating time was 35 minutes. Prophylactic antibiotics were administered before every surgery (100% of cases) according to guidelines. Overall, the audit found that increased operating time was associated with greater complications but duration alone did not determine outcomes; patient and surgery factors were also important. It recommended enhanced recovery after surgery practices to optimize preoperative, intraoperative and postoperative care.
A discussion on the risk factors, classification and clinical presentation of surgical site infection. Also elucidates the overview of management approach to SSI.
A discussion on the risk factors, classification and clinical presentation of surgical site infection. Also elucidates the overview of management approach to SSI.
Prevention of Surgical Site Infection- SSI [compatibility mode]drnahla
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.
Antibiotics for surgical prophylaxis.
Surgical site infections(SSIs) are a significant cause of morbidity and mortality.
Approximately 2% to 5% of patients undergoing clean extra-abdominal operations and 20%undergoing intra-abdominal operations will develop an SSI.
SSIs have become the second most common cause of nosocomial infection and these data are likely underestimated.
Objectives:
•Learn about the current of SSI prevention in Canada
•Review the updated SSI-GSK
•Compare CPSI SSI-GSK to national and international literature
Surgical site Infection during Internship in medical college.pptxrautkrisna
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). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. 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. 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. 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. 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 of between 814 and 6626 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.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). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. 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. 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. 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 wllbeing
According to the National Center for Health Statistics, approximately 46 million surgical procedures are performed annually in the United States, the majority of which are done in an outpatient setting.1
Infection is the most common complication of surgery.2
Surgical site infections (SSIs) occur in approximately 3% to 6% of
patients and prolong hospitalization by an average of 7 days at a direct annual cost of $5 to $10 billion.3,4
SSIs are the third (14%–16%) most frequent cause of nosocomial infections among hospitalized patients.3
Infection occurs within 30 days after the operative procedure if no implant is left in place or within 1 year if implant is in place and the infection appears to be related to the operative procedure
risk factors includes
Age
Obesity
Diabetes
Malnutrition
Prolonged preoperative stay
Infection at remote site
Systemic steroid use
Nicotine use
Background/Objective: The purpose of this study was to discuss some risk factors which may increase risk of infectious morbidity
after cesarean section despite of applying prophylactic measures including skin cleansing and prophylactic antibiotic.
Methods: This single randomized controlled study was conducted at the Obstetrics and Gynecology department, El Minya general hospital, El Minya, Egypt, from January 2017 to January 2018.
LETS KNOW ABOUT - SURGICAL SITE INFECTION(SSI).
Infections of the incision or organ or space, that occur after surgery.
60% of SSIs -preventable with evidence-based guidelines.
MC and costliest hospital-acquired infections, 20% of all hospital infections.
CLAClassified based on the depth and tissue layers .
Superficial incisional SSI
Primary or secondary.
Deep incisional SSI
Primary or secondary.
Organ/space SSI
SUPERFICIAL INCISIONAL SSI
Infection occurs within 30 days after the operative procedure and involves only skin and subcutaneous tissue of the incision and had at least one of the following:
a. Purulent drainage from the superficial incision.
b. Organisms isolated from an aseptically obtained culture of fluid or tissue from the superficial incision.
c. At least one of the following signs or symptoms of infection: pain or tenderness, localized swelling, redness, or heat, and superficial incision is deliberately opened by surgeon and is culture positive or not cultured. A culture-negative finding does not meet this criterion.
d. Diagnosis of superficial incisional SSI by the surgeon or attending physician
DEEP INCISIONAL SSI
Infection occurs within 30 days after the operative procedure if no implant is left in place or within 3 months if implant is in place and the infection appears to be related to the operative procedure and involves deep soft tissues (e.g., fascial and muscle layers) of the incision and patient has at least one of the following:
a. Purulent drainage from the deep incision but not from organ/space component of the surgical site.
b. Deep incision spontaneously dehisces or is deliberately opened by a surgeon and is culture-positive or not cultured when the patient has at least one of the following signs or symptoms: fever (>38°C) or localized pain or tenderness. A culture-negative finding does not meet this criterion.
c. An abscess or other evidence of infection involving the deep incision is found on direct examination, during reoperation, or by histopathologic or radiologic examination.
d. Diagnosis of a deep incisional SSI by a surgeon or attending physician.Wound that has both superficial and deep incisional infection is classified as DIS
ORGAN SPACE SSI
Infection occurs within 30 days after the operative procedure if no implant is left in place or within 3 months if implant is in place and the infection appears to be related to the operative procedure and infection involves any part of the body, excluding the skin incision, fascia, or muscle layers, that is opened or manipulated during the operative procedure and patient has at least one of the following:
a. Purulent drainage from a drain that is placed through a stab wound into the organ/space.
b. Organisms isolated from an aseptically obtained culture of fluid or tissue in the organ/space.
c. An abscess or other evidence of infection involving the organ/space that is found on direct examination, during reoperation, or by histopathologic or radiologic examination.
Tyu
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
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Prevention of Surgical Site Infection- SSI [compatibility mode]drnahla
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.
Antibiotics for surgical prophylaxis.
Surgical site infections(SSIs) are a significant cause of morbidity and mortality.
Approximately 2% to 5% of patients undergoing clean extra-abdominal operations and 20%undergoing intra-abdominal operations will develop an SSI.
SSIs have become the second most common cause of nosocomial infection and these data are likely underestimated.
Objectives:
•Learn about the current of SSI prevention in Canada
•Review the updated SSI-GSK
•Compare CPSI SSI-GSK to national and international literature
Surgical site Infection during Internship in medical college.pptxrautkrisna
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). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. 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. 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. 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. 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 of between 814 and 6626 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.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). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. 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. 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. 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 wllbeing
According to the National Center for Health Statistics, approximately 46 million surgical procedures are performed annually in the United States, the majority of which are done in an outpatient setting.1
Infection is the most common complication of surgery.2
Surgical site infections (SSIs) occur in approximately 3% to 6% of
patients and prolong hospitalization by an average of 7 days at a direct annual cost of $5 to $10 billion.3,4
SSIs are the third (14%–16%) most frequent cause of nosocomial infections among hospitalized patients.3
Infection occurs within 30 days after the operative procedure if no implant is left in place or within 1 year if implant is in place and the infection appears to be related to the operative procedure
risk factors includes
Age
Obesity
Diabetes
Malnutrition
Prolonged preoperative stay
Infection at remote site
Systemic steroid use
Nicotine use
Background/Objective: The purpose of this study was to discuss some risk factors which may increase risk of infectious morbidity
after cesarean section despite of applying prophylactic measures including skin cleansing and prophylactic antibiotic.
Methods: This single randomized controlled study was conducted at the Obstetrics and Gynecology department, El Minya general hospital, El Minya, Egypt, from January 2017 to January 2018.
LETS KNOW ABOUT - SURGICAL SITE INFECTION(SSI).
Infections of the incision or organ or space, that occur after surgery.
60% of SSIs -preventable with evidence-based guidelines.
MC and costliest hospital-acquired infections, 20% of all hospital infections.
CLAClassified based on the depth and tissue layers .
Superficial incisional SSI
Primary or secondary.
Deep incisional SSI
Primary or secondary.
Organ/space SSI
SUPERFICIAL INCISIONAL SSI
Infection occurs within 30 days after the operative procedure and involves only skin and subcutaneous tissue of the incision and had at least one of the following:
a. Purulent drainage from the superficial incision.
b. Organisms isolated from an aseptically obtained culture of fluid or tissue from the superficial incision.
c. At least one of the following signs or symptoms of infection: pain or tenderness, localized swelling, redness, or heat, and superficial incision is deliberately opened by surgeon and is culture positive or not cultured. A culture-negative finding does not meet this criterion.
d. Diagnosis of superficial incisional SSI by the surgeon or attending physician
DEEP INCISIONAL SSI
Infection occurs within 30 days after the operative procedure if no implant is left in place or within 3 months if implant is in place and the infection appears to be related to the operative procedure and involves deep soft tissues (e.g., fascial and muscle layers) of the incision and patient has at least one of the following:
a. Purulent drainage from the deep incision but not from organ/space component of the surgical site.
b. Deep incision spontaneously dehisces or is deliberately opened by a surgeon and is culture-positive or not cultured when the patient has at least one of the following signs or symptoms: fever (>38°C) or localized pain or tenderness. A culture-negative finding does not meet this criterion.
c. An abscess or other evidence of infection involving the deep incision is found on direct examination, during reoperation, or by histopathologic or radiologic examination.
d. Diagnosis of a deep incisional SSI by a surgeon or attending physician.Wound that has both superficial and deep incisional infection is classified as DIS
ORGAN SPACE SSI
Infection occurs within 30 days after the operative procedure if no implant is left in place or within 3 months if implant is in place and the infection appears to be related to the operative procedure and infection involves any part of the body, excluding the skin incision, fascia, or muscle layers, that is opened or manipulated during the operative procedure and patient has at least one of the following:
a. Purulent drainage from a drain that is placed through a stab wound into the organ/space.
b. Organisms isolated from an aseptically obtained culture of fluid or tissue in the organ/space.
c. An abscess or other evidence of infection involving the organ/space that is found on direct examination, during reoperation, or by histopathologic or radiologic examination.
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Annex 21c Clinical audits 3-Gyne (1).pptx
1. Clinical Audit ON
Lower segment caesarean section procedure
Dr. Kabita Sharma
Department of OBG &
GYN
2. CLINICAL AUDIT
OBJECTIVES :
To assess the relation of duration of surgery to
postoperative morbidity like duration of stay at
hospital.
To assess the effects of prophylactic antibiotics with
postoperative SSI, endometritis and urinary tract
infection.
3. Introduction
Caesarean section (CS) rates have increased globally
during the past three decades.
The risks associated with cesarean delivery can be
divided into short term, long term, and those that
present risks to future pregnancies.
Caesarean section -Single most important risk factor
for postpartum maternal infection
.
4. COMPLICATIONS
The major non-anesthesia-related complications related
to caesarean delivery are
Surgical site infection
Endometritis
Urinary tract infection
A major cause of prolonged hospital stay
5. Surgical site infection (SSI) following CS is a common
cause of morbidity with reported rates of 3–15%.
SSI represents a substantial burden to the health system
including increased length of hospitalisation and costs of
post discharge care.
Incidence of surgical site infection following caesarean section: a systematic
review BMJ Open 2017
7. TABLE 1
CRITERIA FOR DEFINING A SURGICAL SITE INFECTION (SSI)
Superficial Incisional SSI
infection occurs within 30 days after the operation
and
infection involves only skin or subcutaneous tissue of the incision
and at least one of the following:
1. Purulent drainage, with or without laboratory confirmation, from the superficial incision.
2. Organisms isolated from an aseptically obtained culture of fluid or tissue from the
superficial incision.
3. At least one of the following signs or symptoms of infection: pain or tenderness,
localized swelling, redness, or heat and superficial incision is deliberately opened by
surgeon, unless incision is culture-negative.
4. Diagnosis of superficial incisional SSI by the surgeon or attending physician.
Do not report the following conditions as SSI:
1. Stitch abscess (minimal inflammation and discharge confined to the points of suture
penetration).
2. Infection of an episiotomy or newborn circumcision site.
3. Infected burn wound.
4. Incisional SSI that extends into the fascial and muscle layers (see deep incisional SSI).
Note: Specific criteria are used for identifying infected episiotomy and circumcision sites and burn
wounds.433
8. Effective interventions to decrease surgical site infection include
Prophylactic antibiotic use
Chlorhexidine skin preparation
Hair removal using clippers instead of razors,
vaginal cleansing by povidone-iodine
Placental removal by traction of the umbilical cord
instead of by manual removal
Suture closure of subcutaneous tissue if the wound
thickness is >2 cm
Skin closure with sutures instead of with staples.
9. Operative duration is independently associated with
increased infectious complications and length of stay
after adjustment for procedure and patient risk factors.
Prophylactic antibiotics use of prophylactic antibiotics
in women undergoing cesarean section reduces the
incidence of wound infection, endometritis and serious
infectious complications by 60% to 70%
10. Period of Audit: SEP 2023 to OCT 2023
Study Design: Retrospective study of LSCS cases
Study Area: Patients who have undergone LSCS procedure
at VINAYAKA HOSPITAL
12. Following parameters were monitored in LSCS patients:
1. Average operating time
2. Adherence of antibiotic prophylaxis protocol with
respect to
a) Choice of antibiotics
b) Timing of antibiotic administration before surgery
14. DATE INCISION TIME CLOSURE TIME
OPERATING
TIME
HOSPITAL STAY
03.09.2023 2:48 PM 3:25 PM 37 mnts. 4 DAYS
14.09.2023 3:30 PM 4:20 PM 50 mnts. 4 DAYS
19.09.2023 1:30 PM 2:15 PM 45 mnts. 3 DAYS
19.09.2023 6:15 PM 6:45 PM 30 mnts. 3 DAYS
22.09.2023 11:55 AM 12:20 PM 25 mnts. 4 DAYS
23.10.2023 10:05 AM 10:30 AM 25 mnts. 3 DAYS
16. Operative duration is independently associated with increased infectious
complications and length of stay after adjustment for procedure and
patient risk factors
Increased operative time was linked with an increased blood loss, low
five-minute Apgar scores and umbilical arterial pH < 7.1.
17. Duration of surgery alone is not a major determinant of
postoperative morbidity and
Important predictors of outcome are
o Type of surgery performed and the
o Patient's general health
o Pre existing conditions such as
Previous surgeries, malpresentations,
lower uterine segment not formed,
prolonged second stage were important
18. Length of hospital stay
Guidelines published by the ACOG suggest that, when
there have been no complications, the duration of
postpartum hospital stays range from an average of 48
hours for vaginal delivery to an average of 96 hours for
cesarean birth (excluding the day of delivery)
19. Early discharge means reduced health care cost
It enables mother to return home sooner with newborn.
Early discharge should not preclude educating woman on breastfeeding,
family planning and care of new born.
The complications should also be monitored to accurately determine the
costs and benefits of early postpartum discharge
21. Antibiotic prophylaxis for caesarean
section
Cefazolin 1-2gm I/V 30-60 min prior to skin incision
OR
Cefuroxime 1.5 gm 30-60 min prior to skin incision
OR
Augmentin 1.2 gm I/V 30 -60 min prior to skin incision
OR
Ceftriaxone 1gm I/V 30-60 min prior to skin incision
24. RECOMMENDATIONS
Enhanced recovery after surgery (ERAS)
A concept that combines various evidence-based aspects of perioperative
care to accelerate patient recovery.
25. (ERAS) Committee guides on perioperative care for
cesarean delivery.
Covers practices from the time of decision making to
hospital discharge
The recommendations are based on a thorough review
of the literature and includes a ‘maternal focused
pathway’ for both scheduled and unscheduled surgeries
