The document discusses establishing a culture of safety and working toward zero surgical site infections at hospitals by forming multidisciplinary teams to address various infection types and implement strategies like pre-operative MRSA screening and decolonization, improving cleaning and sterilization practices in operating rooms, and using incisional adhesives for wound closure to help prevent surgical site infections. It provides examples of protocols and results from various hospitals that showed reductions in MRSA and Staph aureus surgical site infection rates after implementing a pre-operative decolonization and screening program.
This document summarizes the efforts of a multidisciplinary team at New England Baptist Hospital to reduce surgical site infections (SSIs) through identifying issues, implementing action plans, and tracking outcomes from 2003-2010. The team addressed operating room environment and processes, patient risk factors, and use of innovative technologies like chlorhexidine and antibacterial sutures. SSIs decreased over time, including a reduction in MRSA/MSSA infections after implementing a decolonization protocol in 2006.
This document summarizes infection control strategies and outcomes at an orthopedic hospital. It discusses screening patients for MRSA colonization and decolonization protocols, changes to surgical dressings and antibiotics, hand hygiene initiatives, and reductions in surgical site infections after implementing a multidisciplinary approach focused on preventing healthcare-associated infections. Key metrics like MRSA colonization rates and reductions in infection rates post-implementation are highlighted.
This document summarizes an MRSA eradication program implemented at New England Baptist Hospital. It describes increasing rates of MRSA infections, both in the hospital and community. The hospital implemented universal pre-operative MRSA/MSSA screening and decolonization treatment for patients undergoing inpatient surgery to reduce surgical site infections. Rapid PCR testing was used to screen over 6,000 patients annually. While costly to implement, the program aimed to improve patient outcomes and reduce costs associated with treating surgical site infections. Preliminary results showed reduced MRSA colonization and bacteremia post-surgery.
The document provides guidelines from the World Health Organization (WHO) on preventing surgical site infections (SSIs). It discusses 29 recommendations across pre-operative, intra-operative, and post-operative periods. Some key recommendations include using chlorhexidine for skin preparation, mupirocin ointment for nasal carriers of Staphylococcus aureus, appropriate timing of pre-operative antibiotics, and not prolonging antibiotics post-operatively. The guidelines are informed by evidence reviews on topics related to reducing SSI risk and aim to provide guidance based on strength and quality of evidence.
This document provides an outline of José Ramón Paño-Pardo's track at the ICAAC 2015 conference. The conference focused on antimicrobial agents and chemotherapy. Key topics included antimicrobial stewardship, bloodstream infections, new antimicrobials, and clinical infectious disease syndromes. Sessions covered emerging resistance issues like carbapenemase-producing Enterobacteriaceae and rapid diagnostics for sepsis.
_______________________________________
Emergency Procedure? YES NO
Was subclavian or IJ vein the site for insertion?
YES NO
Specify: ________________________
Is the indication for insertion appropriate? YES NO
Date of Patient Discharged:
Surveillance of Healthcare
Associated Infection
Central Line Associated
Bloodstream Infection
Insertion and Maintenance Bundles
The document discusses various chairside diagnostic aids that can be used in periodontal examination. It outlines the limitations of traditional diagnostic methods like clinical and radiographic evaluation. It then describes several advanced diagnostic aids like thermal probes, subtraction radiography. The rationale for developing chairside diagnostic kits is provided which allow immediate reports without specialized equipment. Examples of microbiological, genetic and biochemical chairside test kits are explained in detail, covering their methodology and biomarkers analyzed. Newer diagnostic tests still under development are also mentioned.
This document summarizes the efforts of a multidisciplinary team at New England Baptist Hospital to reduce surgical site infections (SSIs) through identifying issues, implementing action plans, and tracking outcomes from 2003-2010. The team addressed operating room environment and processes, patient risk factors, and use of innovative technologies like chlorhexidine and antibacterial sutures. SSIs decreased over time, including a reduction in MRSA/MSSA infections after implementing a decolonization protocol in 2006.
This document summarizes infection control strategies and outcomes at an orthopedic hospital. It discusses screening patients for MRSA colonization and decolonization protocols, changes to surgical dressings and antibiotics, hand hygiene initiatives, and reductions in surgical site infections after implementing a multidisciplinary approach focused on preventing healthcare-associated infections. Key metrics like MRSA colonization rates and reductions in infection rates post-implementation are highlighted.
This document summarizes an MRSA eradication program implemented at New England Baptist Hospital. It describes increasing rates of MRSA infections, both in the hospital and community. The hospital implemented universal pre-operative MRSA/MSSA screening and decolonization treatment for patients undergoing inpatient surgery to reduce surgical site infections. Rapid PCR testing was used to screen over 6,000 patients annually. While costly to implement, the program aimed to improve patient outcomes and reduce costs associated with treating surgical site infections. Preliminary results showed reduced MRSA colonization and bacteremia post-surgery.
The document provides guidelines from the World Health Organization (WHO) on preventing surgical site infections (SSIs). It discusses 29 recommendations across pre-operative, intra-operative, and post-operative periods. Some key recommendations include using chlorhexidine for skin preparation, mupirocin ointment for nasal carriers of Staphylococcus aureus, appropriate timing of pre-operative antibiotics, and not prolonging antibiotics post-operatively. The guidelines are informed by evidence reviews on topics related to reducing SSI risk and aim to provide guidance based on strength and quality of evidence.
This document provides an outline of José Ramón Paño-Pardo's track at the ICAAC 2015 conference. The conference focused on antimicrobial agents and chemotherapy. Key topics included antimicrobial stewardship, bloodstream infections, new antimicrobials, and clinical infectious disease syndromes. Sessions covered emerging resistance issues like carbapenemase-producing Enterobacteriaceae and rapid diagnostics for sepsis.
_______________________________________
Emergency Procedure? YES NO
Was subclavian or IJ vein the site for insertion?
YES NO
Specify: ________________________
Is the indication for insertion appropriate? YES NO
Date of Patient Discharged:
Surveillance of Healthcare
Associated Infection
Central Line Associated
Bloodstream Infection
Insertion and Maintenance Bundles
The document discusses various chairside diagnostic aids that can be used in periodontal examination. It outlines the limitations of traditional diagnostic methods like clinical and radiographic evaluation. It then describes several advanced diagnostic aids like thermal probes, subtraction radiography. The rationale for developing chairside diagnostic kits is provided which allow immediate reports without specialized equipment. Examples of microbiological, genetic and biochemical chairside test kits are explained in detail, covering their methodology and biomarkers analyzed. Newer diagnostic tests still under development are also mentioned.
Advanced diagnostic aids provide clinicians with improved tools for periodontal diagnosis. Recent advances include more precise periodontal probes that control probing force, non-invasive diagnostic methods like gingival temperature measurement, and improved microbial analysis techniques. Molecular biology techniques allow for detection of specific periodontal pathogens through DNA/RNA analysis and probes. These diagnostic advances enhance detection of disease presence, type, and activity level to improve treatment planning and outcomes.
Fagernes & lingaas (2011) Factors interfering with the microflora on hands. j...Nursing Quality Concept
This study analyzed samples from 465 healthcare workers' hands to determine factors that interfere with normal hand microflora. Multiple regression analysis found that wearing a wristwatch was associated with higher total bacterial counts. Wearing one plain finger ring increased rates of Enterobacteriaceae carriage. Longer fingernails (>2 mm) and recent hand lotion use increased Staphylococcus aureus carriage rates. Occupation also associated with S. aureus and Enterobacteriaceae carriage. The study concludes healthcare workers should remove watches and rings at work and keep fingernails short, and nail polish may be used.
The document describes the Open Source Pharma Foundation (OSPF), a nonprofit organization that uses open source principles to develop low-cost medicines. OSPF's goal is to cut drug discovery costs by 90% and time by 50% compared to traditional pharmaceutical models. Key points:
- OSPF uses computational discovery, crowdsourced preclinical work, open source clinical trials, and generic manufacturing to develop drugs affordably.
- Disease focus areas include respiratory pandemics like tuberculosis and COVID-19. Main strategy is "lateral discovery" through drug repurposing.
- OSPF has centers in Bangalore, Paris, and New York with collaborations with institutions like Mayo Clinic and
BUMEDINST 6600.10, Dental Infection Control ProgramShayne Morris
This document provides guidance on infection control procedures for dental personnel. It discusses hazards like Hepatitis B Virus and the need for universal precautions when treating all patients. Proper use of personal protective equipment, sterilization of instruments, dental unit waterline maintenance, sharps disposal and other work practices are outlined to prevent transmission of bloodborne pathogens in dental settings. Commanding officers must implement an infection control program and appoint an infection control officer to oversee training and ensure compliance with these policies.
Dr. Jean-Pierre Vaillancourt - Can You Keep High Path Avian Influenza from En...John Blue
Can You Keep High Path Avian Influenza from Entering Your Operation? - Dr. Jean-Pierre Vaillancourt, University of Montreal, Quebec, from the 2016 NIAA Annual Conference: From Farm to Table - Food System Biosecurity for Animal Agriculture, April 4-7, 2016, Kansas City, MO, USA.
More presentations at http://www.trufflemedia.com/agmedia/conference/2016_niaa_farm_table_food_system_biosecurity
Blood Culture Contamination at RUMC, A clinicians PerspectiveLuis Beverido
This document discusses reducing blood culture contamination rates at RUMC. It notes that target contamination rates are 2-3% and the median rate is 2.92%. The document explores how contamination affects patient care/safety, costs, and financial implications. It provides data on RUMC's contamination rates by unit from July-September 2013. The document proposes strategies to reduce contamination through education and process changes.
Infection prevention and Control SOP ( Fisseha Eshete)Fisseha Eshete
This document outlines an infection prevention and control standard operating procedure for Rumbek State Hospital in South Sudan. It defines responsibilities for hospital staff, outlines universal precautions and protocols for personal protective equipment, and describes proper waste segregation, treatment, and disposal. It also provides recommendations for establishing an infection prevention program, including ensuring access to clean water, adequate handwashing facilities, supplies for personal protection and cleaning/disinfection, and proper waste management. The goal is to provide safety for patients and employees through infection control practices.
CDC Director Releases After-Action Report on Recent Anthrax Incident; Highlights Steps to Improve Laboratory Quality and Safety http://www.cdc.gov/od/science/integrity/docs/Final_Anthrax_Report.pdf
Bharat Naik is an experienced medical technologist and laboratory manager seeking a management position. He has over 20 years of experience as a clinical lab technologist and 7 years of management experience. He has extensive technical expertise in areas like medical microbiology, clinical chemistry, hematology, immunohaematology, cytogenetics, and quality control. Naik has a PhD in medical science and is certified in New York, Canada, and India. His resume demonstrates a track record of leading laboratories and ensuring compliance with regulations.
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research paper publishing, where to publish research paper, journal publishing, how to publish research paper, Call for research paper, international journal, publishing a paper, call for paper 2012, journal of pharmacy, how to get a research paper published, publishing a paper, publishing of journal, research and review articles, Pharmacy journal, International Journal of Pharmacy, hard copy of journal, hard copy of certificates, online Submission, where to publish research paper, journal publishing, international journal, publishing a paper
The document discusses surgical site infections (SSIs), including:
1. SSIs are defined as infections occurring within 30 days of surgery or 1 year if an implant is placed. Common types are superficial and deep incisional infections.
2. SSIs are among the most common and costly healthcare-associated infections, with incidence higher following some orthopedic procedures.
3. Risk factors for SSIs include patient characteristics like diabetes as well as surgical factors like prolonged operating time and implant use. Proper prevention techniques can help reduce SSI risk.
4. Diagnosis involves clinical presentation as well as microbiological and histological testing. Treatment depends on infection severity but often involves wound opening, debride
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.
Surgical site infections can involve the skin, tissues below the skin, or implanted materials where surgery took place. To prevent such infections, doctors and nurses take several measures like cleaning hands and arms with antiseptics before surgery, wearing protective clothing during surgery, and cleaning the skin at the surgery site with special germ-killing soap. It is important for healthcare facilities to evaluate and ensure staff follow infection control policies, especially in outpatient areas like dressing change rooms, to prevent the spread of infections. Bacteriological culture testing of infected surgical sites helps identify causing organisms and guide appropriate antibiotic treatment, but samples must be properly collected by trained staff.
Presented by Dr. Hall at the 40th Annual Symposium "Diagnostic and Clinical Challenges of 20th Century Microbes", held on Nov 18, 2010 in Philadelphia.
This document discusses surgical site infections (SSIs), including definitions, risk factors, prevention, and treatment. Some key points:
- SSIs are infections that occur within 30 days of surgery (1 year if an implant is used) and are classified by location and time of onset.
- Risk factors include patient characteristics (age, diabetes), surgical factors (duration, contamination), and environmental factors (operating room quality).
- Prevention includes preoperative skin antisepsis, proper antimicrobial prophylaxis during surgery, and maintaining normothermia. Postoperative wound care and surveillance are also important.
- Signs of an SSI include wound erythema, pain, swelling or discharge. Treatment
This document discusses treatment approaches for early stage cervical cancer. It notes that for invasive cervical cancers measuring less than 2 cm, removal of the parametrium may be omitted. For some very small tumors, pelvic lymphadenectomy can also be omitted as the risk of lymph node metastasis is limited. It also discusses outcomes from vaginal trachelectomy and laparoscopic pelvic lymphadenectomy for early stage cancers. The document considers conservative treatment approaches for stage IA2-IB1 cancers less than 3 cm in size, including a proposed study design stratifying patients based on tumor diameter.
The correct application of the safety check steps in our routine theatre operations and procedures will greatly reduce surgically related mortality and morbidity.
Infec control measures in icu day in life of bacterium-mghwanted1361
The document discusses infection control measures in the ICU, noting that bacteria can easily spread between patients and healthcare workers through contact with skin and the environment, and that proper hand hygiene is the cornerstone of prevention. It also presents data showing that hand hygiene compliance rates are lowest among physicians, and that a multifaceted campaign including incentives significantly improved hand hygiene rates and reduced MRSA infections at Massachusetts General Hospital.
This presentation discusses healthcare worker safety issues. It covers topics like blood and body fluid exposure, personal protective equipment, immunizations, safe equipment use, isolation precautions, sharp injuries, and post-exposure prophylaxis. Data showed that nurses comprised the largest percentage of workers injured. The presentation calls for greater accountability, education, surveillance, and use of safety devices to protect healthcare workers.
Advanced diagnostic aids provide clinicians with improved tools for periodontal diagnosis. Recent advances include more precise periodontal probes that control probing force, non-invasive diagnostic methods like gingival temperature measurement, and improved microbial analysis techniques. Molecular biology techniques allow for detection of specific periodontal pathogens through DNA/RNA analysis and probes. These diagnostic advances enhance detection of disease presence, type, and activity level to improve treatment planning and outcomes.
Fagernes & lingaas (2011) Factors interfering with the microflora on hands. j...Nursing Quality Concept
This study analyzed samples from 465 healthcare workers' hands to determine factors that interfere with normal hand microflora. Multiple regression analysis found that wearing a wristwatch was associated with higher total bacterial counts. Wearing one plain finger ring increased rates of Enterobacteriaceae carriage. Longer fingernails (>2 mm) and recent hand lotion use increased Staphylococcus aureus carriage rates. Occupation also associated with S. aureus and Enterobacteriaceae carriage. The study concludes healthcare workers should remove watches and rings at work and keep fingernails short, and nail polish may be used.
The document describes the Open Source Pharma Foundation (OSPF), a nonprofit organization that uses open source principles to develop low-cost medicines. OSPF's goal is to cut drug discovery costs by 90% and time by 50% compared to traditional pharmaceutical models. Key points:
- OSPF uses computational discovery, crowdsourced preclinical work, open source clinical trials, and generic manufacturing to develop drugs affordably.
- Disease focus areas include respiratory pandemics like tuberculosis and COVID-19. Main strategy is "lateral discovery" through drug repurposing.
- OSPF has centers in Bangalore, Paris, and New York with collaborations with institutions like Mayo Clinic and
BUMEDINST 6600.10, Dental Infection Control ProgramShayne Morris
This document provides guidance on infection control procedures for dental personnel. It discusses hazards like Hepatitis B Virus and the need for universal precautions when treating all patients. Proper use of personal protective equipment, sterilization of instruments, dental unit waterline maintenance, sharps disposal and other work practices are outlined to prevent transmission of bloodborne pathogens in dental settings. Commanding officers must implement an infection control program and appoint an infection control officer to oversee training and ensure compliance with these policies.
Dr. Jean-Pierre Vaillancourt - Can You Keep High Path Avian Influenza from En...John Blue
Can You Keep High Path Avian Influenza from Entering Your Operation? - Dr. Jean-Pierre Vaillancourt, University of Montreal, Quebec, from the 2016 NIAA Annual Conference: From Farm to Table - Food System Biosecurity for Animal Agriculture, April 4-7, 2016, Kansas City, MO, USA.
More presentations at http://www.trufflemedia.com/agmedia/conference/2016_niaa_farm_table_food_system_biosecurity
Blood Culture Contamination at RUMC, A clinicians PerspectiveLuis Beverido
This document discusses reducing blood culture contamination rates at RUMC. It notes that target contamination rates are 2-3% and the median rate is 2.92%. The document explores how contamination affects patient care/safety, costs, and financial implications. It provides data on RUMC's contamination rates by unit from July-September 2013. The document proposes strategies to reduce contamination through education and process changes.
Infection prevention and Control SOP ( Fisseha Eshete)Fisseha Eshete
This document outlines an infection prevention and control standard operating procedure for Rumbek State Hospital in South Sudan. It defines responsibilities for hospital staff, outlines universal precautions and protocols for personal protective equipment, and describes proper waste segregation, treatment, and disposal. It also provides recommendations for establishing an infection prevention program, including ensuring access to clean water, adequate handwashing facilities, supplies for personal protection and cleaning/disinfection, and proper waste management. The goal is to provide safety for patients and employees through infection control practices.
CDC Director Releases After-Action Report on Recent Anthrax Incident; Highlights Steps to Improve Laboratory Quality and Safety http://www.cdc.gov/od/science/integrity/docs/Final_Anthrax_Report.pdf
Bharat Naik is an experienced medical technologist and laboratory manager seeking a management position. He has over 20 years of experience as a clinical lab technologist and 7 years of management experience. He has extensive technical expertise in areas like medical microbiology, clinical chemistry, hematology, immunohaematology, cytogenetics, and quality control. Naik has a PhD in medical science and is certified in New York, Canada, and India. His resume demonstrates a track record of leading laboratories and ensuring compliance with regulations.
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research paper publishing, where to publish research paper, journal publishing, how to publish research paper, Call for research paper, international journal, publishing a paper, call for paper 2012, journal of pharmacy, how to get a research paper published, publishing a paper, publishing of journal, research and review articles, Pharmacy journal, International Journal of Pharmacy, hard copy of journal, hard copy of certificates, online Submission, where to publish research paper, journal publishing, international journal, publishing a paper
The document discusses surgical site infections (SSIs), including:
1. SSIs are defined as infections occurring within 30 days of surgery or 1 year if an implant is placed. Common types are superficial and deep incisional infections.
2. SSIs are among the most common and costly healthcare-associated infections, with incidence higher following some orthopedic procedures.
3. Risk factors for SSIs include patient characteristics like diabetes as well as surgical factors like prolonged operating time and implant use. Proper prevention techniques can help reduce SSI risk.
4. Diagnosis involves clinical presentation as well as microbiological and histological testing. Treatment depends on infection severity but often involves wound opening, debride
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.
Surgical site infections can involve the skin, tissues below the skin, or implanted materials where surgery took place. To prevent such infections, doctors and nurses take several measures like cleaning hands and arms with antiseptics before surgery, wearing protective clothing during surgery, and cleaning the skin at the surgery site with special germ-killing soap. It is important for healthcare facilities to evaluate and ensure staff follow infection control policies, especially in outpatient areas like dressing change rooms, to prevent the spread of infections. Bacteriological culture testing of infected surgical sites helps identify causing organisms and guide appropriate antibiotic treatment, but samples must be properly collected by trained staff.
Presented by Dr. Hall at the 40th Annual Symposium "Diagnostic and Clinical Challenges of 20th Century Microbes", held on Nov 18, 2010 in Philadelphia.
This document discusses surgical site infections (SSIs), including definitions, risk factors, prevention, and treatment. Some key points:
- SSIs are infections that occur within 30 days of surgery (1 year if an implant is used) and are classified by location and time of onset.
- Risk factors include patient characteristics (age, diabetes), surgical factors (duration, contamination), and environmental factors (operating room quality).
- Prevention includes preoperative skin antisepsis, proper antimicrobial prophylaxis during surgery, and maintaining normothermia. Postoperative wound care and surveillance are also important.
- Signs of an SSI include wound erythema, pain, swelling or discharge. Treatment
This document discusses treatment approaches for early stage cervical cancer. It notes that for invasive cervical cancers measuring less than 2 cm, removal of the parametrium may be omitted. For some very small tumors, pelvic lymphadenectomy can also be omitted as the risk of lymph node metastasis is limited. It also discusses outcomes from vaginal trachelectomy and laparoscopic pelvic lymphadenectomy for early stage cancers. The document considers conservative treatment approaches for stage IA2-IB1 cancers less than 3 cm in size, including a proposed study design stratifying patients based on tumor diameter.
The correct application of the safety check steps in our routine theatre operations and procedures will greatly reduce surgically related mortality and morbidity.
Infec control measures in icu day in life of bacterium-mghwanted1361
The document discusses infection control measures in the ICU, noting that bacteria can easily spread between patients and healthcare workers through contact with skin and the environment, and that proper hand hygiene is the cornerstone of prevention. It also presents data showing that hand hygiene compliance rates are lowest among physicians, and that a multifaceted campaign including incentives significantly improved hand hygiene rates and reduced MRSA infections at Massachusetts General Hospital.
This presentation discusses healthcare worker safety issues. It covers topics like blood and body fluid exposure, personal protective equipment, immunizations, safe equipment use, isolation precautions, sharp injuries, and post-exposure prophylaxis. Data showed that nurses comprised the largest percentage of workers injured. The presentation calls for greater accountability, education, surveillance, and use of safety devices to protect healthcare workers.
Objectives:
•Learn about the current of SSI prevention in Canada
•Review the updated SSI-GSK
•Compare CPSI SSI-GSK to national and international literature
This document summarizes a study on surgical site infections (SSIs) following elective general surgery cases. The study aimed to identify the incidence and risk factors of SSIs, common causative organisms, and antibiotic sensitivity patterns. The overall SSI rate was 4.57%. The most common type of SSI was superficial infections. Staphylococcus aureus was the most commonly isolated organism. Antibiotics like linezolid, amikacin and cefotaxim were generally effective. SSIs increased hospital stay by an average of 10 days and posed significant morbidity.
This document discusses surgical site infections (SSIs), including their definition, incidence, microbiology, pathogenesis, diagnosis, risk factors, prevention, and treatment. Some key points:
1. The CDC revised the definition of "wound infection" in 1992 to distinguish between surgical incision infections and traumatic wound infections.
2. SSIs are usually caused by the patient's skin flora or bacteria introduced during surgery. They occur within 30 days of an operation or 1 year if an implant is inserted.
3. Risk factors include age, diabetes, obesity, smoking, and surgical factors like wound class and duration. Prevention focuses on patient optimization, skin antisepsis, tight glucose control, and appropriate
— The microbiological content of Lettuce (a vegetable), commonly vended in the Benin metropolis of Edo state were evaluated. Five vending locations were chosen for the study. Whole and soft rot samples were purchased and analysed for microbiological composition. Results showed high counts in soft rot samples in lettuce. Nutrient agar plated lettuce samples had bacterial counts in the range of 2.0x 103 to 4.7x10 7. Pseudomonas species was the dominant species found in lettuce samples. Bacillus species was isolated from one location in the lettuce samples. Mac Conkey agar plated lettuce plated had bacterial counts in the range of 2.3 x 10 3 to 5.7x 10 7. Enterobacter species, E. coli, and Klebsiella species were the dominant species isolated. Though, Proteus species was isolated from lettuce samples obtained from location five only. The study observes that consuming soft rot samples could pose a risk of introducing pathogens to the consumer due to their high microbial counts and could be detrimental to the health of the consumer.
The document discusses the changing paradigm in dental care from the nonspecific plaque hypothesis (NSPH) to the specific plaque hypothesis (SPH). It summarizes the key differences between the two approaches. The NSPH assumed all plaque was equally pathogenic, while more recent evidence shows only certain plaque bacteria cause infections. The SPH recognizes healthy and infected plaque can be differentiated microbiologically, enabling more targeted treatment of the infection-causing bacteria.
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.
This document summarizes a study on the prevalence of Methicillin-Resistant Staphylococcus aureus (MRSA) among surgical patients visiting hospitals in Kathmandu Valley, Nepal. The study found a MRSA prevalence of 9.9%. MRSA prevalence was higher in males, older patients, those with longer hospital stays, and those with wound or tissue samples. All MRSA strains showed resistance to multiple antibiotics and were considered multi-drug resistant. Vancomycin was found to be an effective antibiotic against MRSA.
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.
Similar to Establishing a culture of safety april 2012 (20)
This document summarizes information about methicillin-resistant Staphylococcus aureus (MRSA). It discusses what MRSA is, how antibiotic resistance develops, risk factors for acquiring MRSA, methods of transmission, prevention strategies, and the results of a pre-surgical screening and decolonization program that significantly reduced MRSA surgical site infections.
Clostridium difficile is a spore-forming bacterium that can cause antibiotic-associated diarrhea and colitis. It is transmitted through the fecal-oral route via contaminated surfaces or hands. Antibiotic use disrupts normal gut flora and allows C. difficile to cause infection. Symptoms range from mild diarrhea to life-threatening complications. Treatment involves discontinuing antibiotics if possible and using metronidazole or vancomycin for severe cases. Preventing transmission requires contact precautions, thorough hand hygiene and environmental disinfection.
This document provides information about Staphylococcus aureus (staph), including methicillin-sensitive Staph aureus (MSSA) and methicillin-resistant Staph aureus (MRSA). It discusses the emergence of antibiotic resistance in staph over time, risk factors for MRSA infection, differences between community-acquired and healthcare-associated MRSA, and treatment approaches for soft tissue infections.
This document discusses the history of infection control from ancient times to modern practices. It covers various ancient civilizations that practiced early forms of infection control and hygiene. It then discusses key figures and discoveries in medical history that advanced the germ theory of disease and modern infection control practices, such as antisepsis, antibiotics, and the roles of hospitals and regulations in preventing healthcare-associated infections. Risk factors and differences between community-associated and healthcare-associated MRSA are also covered. The effects of diet, stress, and lifestyle on immune function are discussed in relation to infection risk. Infection control practices for complementary therapies are proposed.
The document discusses strategies for evidence-based hygiene and infection prevention. It covers the skin as the body's largest organ and first line of defense. Key points include proper skin assessment; preventing surgical site, pressure ulcer and other infections; strategies like chlorhexidine use and silver dressings; incontinence care; catheter care; and oral hygiene. It also summarizes a successful MRSA/Staph aureus decolonization program and creative hand hygiene strategies using social learning techniques.
The document describes social learning theories and techniques that can be used to influence hand hygiene practices, including role modeling, self-efficacy, reinforcement, and contracting. It provides examples of how these concepts have been applied in healthcare settings through programs like infection control liaisons and educational campaigns promoting hand hygiene.
Clostridium difficile is an anaerobic spore-forming bacterium that can cause infection through fecal-oral transmission. Antibiotic use is a major risk factor as it disrupts the normal gut flora and allows C. difficile to grow. Symptoms range from mild diarrhea to life-threatening conditions. Outbreaks have increased in hospitals and been linked to certain antibiotics like fluoroquinolones. Control measures include environmental decontamination and restricting antibiotic use.
The major pathogens that lead to surgical site infections (SSIs) are Staphylococcus aureus, Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus (MRSA), and methicillin-resistant Staphylococcus epidermidis (MRSE). There are four classes of surgical wound categories and comprehensive infection control protocols include dozens of preoperative, intraoperative, and postoperative measures. However, SSIs are still costly due to longer hospitalization, increased mortality, and higher costs for both hospitals and patients ranging from $400 to over $30,000 per infection.
A hospital identified an increase in CDI cases on one nursing unit after adopting new surveillance definitions for CDI. An investigation found most cases were on a single unit and some patients had been transferred between units in the same bed. The hospital formed a CDI team who implemented enhanced cleaning and education. This included using bleach wipes, changing transfer procedures, and retroactively reviewing cases. As a result, CDI rates decreased from 7.3 to 4.6 per 10,000 patient days between 2008-2009 after implementing targeted interventions.
The document summarizes surveillance and prevention of healthcare-associated infections (HAI) at New England Baptist Hospital. It describes common types of HAI, risk factors, sources of infection transmission including hands and equipment, and infection control precautions and techniques used to prevent the spread of pathogens like MRSA, VRE, and Clostridium difficile. It also discusses the hospital's preoperative screening program for reducing surgical site infections and overall HAI rates.
The document is a collection of essays about yoga in America from various yoga teachers and practitioners. It includes over 30 essays on topics like the history and philosophy of yoga, different yoga styles, personal experiences with yoga, and what yoga means to different people. The introduction provides background on how the book was compiled from open submissions in response to an invitation for authors to write about what yoga means to them.
The document discusses the chakra system as a subtle energy system in the body. It describes the 7 major chakras located along the spinal cord, starting from the root chakra at the base of the spine to the crown chakra at the top of the head. Each chakra is associated with a specific gland or part of the body and governs different physical, mental and emotional attributes when balanced versus imbalanced. The balanced flow of energy through the chakras supports overall health and well-being.
The document provides an overview of yoga, including definitions of yoga, the main branches of yoga practice, common Hatha yoga styles, the eight limbs of Raja yoga, meditation techniques, hand gestures (mudras), core breathing exercises (pranayama), and bandhas that are used in yoga for focus, heat generation, and energy flow. It describes the benefits of yoga and meditation for mind, body, and spirit unification and harmonization.
The document discusses the anatomy and physiology of the subtle energy system and central nervous system. It describes the aura, meridians, chakras, and nadis that make up the subtle energy system. It then explains the structure and function of the central nervous system, including the brain, spinal cord, and autonomic nervous system. Finally, it discusses how yoga, sound therapy, and energy work can influence the subtle energy system and enhance physical and emotional well-being.
1) Ayurveda can help explain why different yoga poses make people feel calm or agitated. According to Ayurveda, different people require different yoga practices based on their individual constitution and current imbalances.
2) A woman who felt nervous and had chronic neck pain learned through Ayurveda that the poses she was practicing aggravated her subtle energies. She modified her practice with poses better suited to her constitution and eliminated her issues.
3) Ayurveda and yoga are intertwined, both aiming to balance the body and mind. Ayurveda teaches diet and lifestyle practices while yoga is a practical means to this end through asana practice and meditation.
This document discusses yoga as a treatment for diabetes and obesity. It provides information on what diabetes and obesity are, their causes and symptoms, and existing treatments. It then explains how various yoga practices like asanas, sun salutations, and pranayama can help reduce weight and control blood sugar levels by strengthening the body and improving organ function. Regular yoga practice is said to help manage weight and diabetes in a permanent yet gentle manner.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
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1. Establishing a Culture of Safety:
Working Toward Zero
Orthopedic SSIs
Maureen Spencer, RN, M.Ed, CIC
Infection Preventionist Consultant
Boston, MA
Email: maureen_spncr@yahoo.com
www.workingtowardzero.com
www.creativehandhygiene.com
2. Example of Working Toward Zero Team Members
The teams:
Surgical Site Infections: Director Surgical Services, OR Manager, SPD Director, Infection
Control Manager, Two Surgeons, VP Patient Care Services, Director of Nursing, Nursing
Manager, Clinical Educator, Microbiology Lab Director
Ventilator Associated Pneumonia: ICU Hospitalist, ICU Nurse Manager, ICU Nurse, Director of
Anesthesia, ICU Clinical Educator, Respiratory Therapy, Infection Control Manager, Micro Lab
Central Line Assoc Bloodstream Infections: Surgeon who inserted most central lines, ICU
Manager, Director of Anesthesia, ICU Clinical Educator, ICU Nurse, Infection Control Manager
Catheter Assoc UTI: Clinical Educator, Infection Control Manager, Chief Urology, Lab Director
MRSA Elimination: Infection Control Manager, Pre-admission testing, OR Director,
Microbiology Lab Director, Two Surgeons, Director of Nursing, Patient Access Director,
Information Technology, ID physician
C.difficile: Chiefs of Surgery and Gastroenterology, ICU Nurse Manager, Micro Lab Director,
Infection Control Manager
2
3. Post-op:
Irrigation? Incisional Patient
adhesive should education is
Consider using be the number extremely
Intraoperative: saline or new one consideration important since
CHG/alcohol CHG (0.05%) for wound many patients
skin prep, irrigant and closure – are discharged
antibacterial eliminate prevents early in the
Pre-op: sutures, expensive and dehiscence and post-op period
incisional toxic exogenous and have
Screen for MRSA bacitracin/polymi
and Staph aureus adhesive contamination to incisions that are
xin or antibiotic wound in the exudative
CHG pre-op irrigant
shower or cleanse If not used state of wound
with impregnated consider covering healing
cloths incision for length
Assure OR meets of hospitalization
AORN standards of
practice
4. MRSA and Staph aureus
Elimination Program Before Patients Enter
the Hospital for Surgery
Prescreening Process
Topical Decolonization Protocol
Vancomycin for MRSA
1. Kim D, Spencer M, Davidson S, et al. J Bone Joint Surg 2010;92:1820-6
2. Spencer M, Kim D, et al: AAOS, 2010
4
5. Provided Evidence: February 2006
Anonymous Nares Cultures To Prove to Administration Patients Are Colonized
With Staph aureus and MRSA
N = 133 patients anonymously surveyed and
cultured in OR after anesthetized
Purpose: to determine pre-op MRSA and Staph
aureus colonization rates for administration
Results:
38 – Staph aureus (29%)
*5 - MRSA ( 4%)
*all undiagnosed, no precautions used in OR,
PACU, postop nursing unit
*MRSA cases received Cefazolin for surgical
5 prophylaxis – THE WRONG ANTIBIOTIC!
6. Implemented Decolonization Protocol
• 5-day application of intranasal 2% mupirocin -
applied twice daily - for MRSA and Staph aureus
positive patients
• Prescription called in by Nurse Practitioner in
prescreening unit
• Daily body wash with chlorhexidine (purchased
by patient)
• MRSA Patients – Unique sticker system to notify
Pre-surgery Unit of Vancomycin surgical
prophylaxis
6
8. Pre-op MRSA and S. aureus Decolonization
Results:
Timeframe: July 17, 2006 through September 2010
Infection rate: 20,065 patient screened
5,988 (23%) positive for Staph aureus
1,027 ( 4%) positive for MRSA
Effectiveness: Repeat nasal screens on MRSA patients
revealed 77% eradication
8
9. Pre-op MRSA and S. aureus Decolonization
Results: % MRSA and S. aureus SSI
Inpatient # of Surgical
Time Period %MRSA/MSSA
Surgeries Infections
FY06
10/01/05-07/16/06* 5,293* 24* 0.45%*
*Historical Controls
FY07
07/17/06-09/30/07 7,019 6 0.08%
FY08
10/01/07-09/30/08 6,323 7 0.11%
FY09
10/01/08-09/30/09 6,364 11 0.17%
FY10
10/01/10-09/30/10 6,437 6 0.09%
9
10. Pre-op MRSA Decolonization
Results: % MRSA SSI in Screened Patients
Inpatient # MRSA #Infect/#MRSA
Time Period MRSA%
Surgeries SSIs +
FY06
10/01/05-07/16/06 5,293 10 (NA) 0.19% NA
FY07
07/17/06-09/30/07 7,019 3 (3+) 0.04% 3/309 (0.97%)
FY08
10/01/07-09/30/08 6,245 4 (2+) 0.06% 2/242 (0.83%)
FY09
10/01/08-09/30/09 6,336 6* (2+) 0.09% 2/234 (0.85%)
FY10
10/01/10-09/30/10 6,437 1 (1+) 0.01% 1/266 (0.37%)
* isolates have been sent for pulse field gel electrophoresis
10 5 of the 6 isolates were available for PFGE and were not related genetically
12. OR Risk Factors:
Contamination from OR Staff
• Reviewed orderlies and room turnover procedures
• Improved traffic control
– new signage and monitoring system
keep room doors closed and minimize traffic
• Eliminate surgical caps – do not cover hair!
• Cloth cap use – if worn, must be covered in OR room
with disposable cap - hair coverage monitored
– Hair harbors organisms
– Staff sweat in cloth caps
– How often do they get washed? Hospital laundered
– Where are they stored?
– Would you eat a meal with hair in it?
– Why allow hair to potentially fall into
surgical incisions?
12
13. OR Risk Factors:
Cleaning/Sterilization of Instruments
• Inspection of Orthopedic Instruments
– Lumens, grooves, sorting, hand cleaning,
disassembly required – massive kits
– Many instruments cannot be disassembled
• Instituted better pre-soaking and rinsing of
tissue and blood from the instruments in the
operating room before decontamination
• There was a recent outbreak investigated by
CDC of shoulder infections - found shavers and
cannulas with biofilm and tissue observed inside
instruments with small camera
13
14. Pathogens survive on surfaces
Organism Survival period
Clostridium difficile 35- >200 days.2,7,8
Methicillin resistant Staphylococcus aureus (MRSA) 14- >300 days.1,5,10
Vancomycin-resistant enterococcus (VRE) 58- >200 days.2,3,4
Escherichia coli >150- 480 days.7,9
Acinetobacter 150- >300 days.7,11
Klebsiella >10- 900 days.6,7
Salmonella typhimurium 10 days- 4.2 years.7
Mycobacterium tuberculosis 120 days.7
Candida albicans 120 days.7
Most viruses from the respiratory tract (eg: corona, Few days.7
coxsackie, influenza, SARS, rhino virus)
Viruses from the gastrointestinal tract (eg: astrovirus, HAV, 60- 90 days.7
polio- or rota virus)
Blood-borne viruses (eg: HBV or HIV) >7 days.5
1. Beard-Pegler et al. 1988.. J Med Microbiol. 26:251-5. 7. Kramer et al. 2006. BMC Infect Dis. 6:130.
2. BIOQUELL trials, unpublished data. 8. Otter and French. 2009. J Clin Microbiol. 47:205-7.
3. Bonilla et al. 1996. Infect Cont Hosp Epidemiol. 17:770-2 9. Smith et al. 1996. J Med. 27: 293-302.
4. Boyce. 2007. J Hosp Infect. 65:50-4. 10. Wagenvoort et al. 2000. J Hosp Infect. 45:231-4.
5. Duckworth and Jordens. 1990. J Med Microbiol. 32:195-200. 11. Wagenvoort and Joosten. 2002. J Hosp Infect. 52:226-7.
6. French et al. 2004. ICAAC.
15. Why Better Environmental Cleaning?
Prior room occupancy increases risk
Study Healthcare associated pathogen Likelihood of patient acquiring HAI
based on prior room occupancy
(comparing a previously ‘positive’
room with a previously ‘negative’
room)
Martinez 20031 VRE – cultured within room 2.6x
VRE – prior room occupant 1.6x
Huang 20062
MRSA – prior room occupant 1.3x
VRE – cultured within room 1.9x
VRE – prior room occupant 2.2x
Drees 20083
VRE – prior room occupant in previous two
2.0x
weeks
Shaughnessy 20084 C. difficile – prior room occupant 2.4x
A. baumannii – prior room occupant 3.8x
Nseir 20105
P. aeruginosa – prior room occupant 2.1x
1. Martinez et al. Arch Intern Med 2003; 163: 1905-12.
2. Huang et al. Arch Intern Med 2006; 166: 1945-51.
3. Drees et al. Clin Infect Dis 2008; 46: 678-85.
4. Shaughnessy. ICAAC/IDSA 2008. Abstract K-4194.
5. Nseir et al. Clin Microbiol Infect 2010 (in press).
16. Rates of Surface Contamination (in hospitals) with MSRA,
VRE, and C. Difficile
Blood Pressure
Cuff: Windowsill:
VRE 14% C. Difficile 33%
Commode:
Overbed Table:
C. Difficile 41%
MRSA 40%
VRE 20% Patient Gowns:
MRSA 51%
Bedrail:
MRSA 29% Floors:
VRE 28% MRSA 55%
C. Difficile 19% C. Difficile 48%
Bedsheets:
MRSA 53%
Did you know that every time you get a new roommate, there is an
VRE 40%
increase of 3-10% that you will acquire an HAI.
Huang SS, Datta R, Platt R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med.
2006 Oct 9;166(18):1945-51
Boyce J.M. et al.: Environmental contamination due to methicillin-resistant Staphylococcus aureus: Possible infection control implications. Infect Control Hosp Epidemiol 18:622-627, Sep. 1997.
Slaughter S., et al.: A comparison of the effect of universal use of gloves and gowns with that of glove use alone on acquisition of vancomycin-resistant enterococci in a medical intensive care
unit. Ann Intern Med 125: 448-456, Sep 15, 1996.
Samore M.H., et al.: Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med 100:32-40, Jan. 1996.
17. Environmental Disinfection – Joint
Commission and CMS Focus on Surveys
Developed cleaning schedules for Patient Care
Services – what equipment, how
cleaned/disinfected, how often, by who, contact
times for disinfectants?
Eliminate dirty buckets of water and string mops
institute micro fiber cloths and mops
Assure staff know proper cleaning technique:
left to right, high to low, clean to dirty with
competencies
Daily check sheet for terminal cleaning of OR at
night and for all precaution cases
17
18. Decontamination of Portable Equipment
with Contracted Services
Ultrasonic scrub
Movable carts
Tables
Poles
Small equipment
1500 pieces cleaned
OR, radiology, nursing
Cost: ~$20,000 / year
APIC 2005 Poster
M Spencer, at al: The E=MC2 Project: Environment = Maintaining Cleanliness: A Multidisciplinary Approach To
Establish a Routine Cleaning Schedule for Medical Equipment.
18
19. SSI risk can be addressed by
controlling risk factors
Precautions are already in place to control the risk of bacterial
contamination throughout the peri-operative period
However, additional controllable risk factors remain – wound
closure provides an opportunity to address these risks
Controlled Risks Potentially Uncontrolled Risks
Scrubbing in ☐ Bacterial colonization of the suture
Gowning ☐ Contamination of the incisional site
Skin antisepsis after the wound is closed
Controlling OR environment ☐ Entry of bacteria from the skin during
Sterilizing instruments wound closure
Using minimally invasive techniques ☐ Bacterial infiltration due to dehiscence
19
20. Uncontrolled Risk Factor:
Bacterial colonization of the suture
Like all foreign bodies, sutures can be colonized by bacteria:
Implants provide nidus for attachment of bacteria1
Bacterial colonization can lead to biofilm formation1
Biofilm formation increases the difficulty of treating an infection2
On an implant, such as a
suture, it takes only 100
staphylococci per gram of
tissue for an SSI to develop3
Contamination Colonization Biofilm
Formation
1. Ward KH et al. J Med Microbiol. 1992;36: 406-413.
2. Kathju S et al Surg infect. 2009;10:457-461
20
3. Mangram AJ et al. Infect Control Hosp Epidemiol.1999;27:97-134..
21. Why Plus Suture?
OR Air Current Contamination
In teaching hospitals:
Surgeon leaves room
Resident, Physician Assistant or Nurse
Practitioner work on incision
Circulating Nurse counts sponges and
starts room breakdown
Scrub Technician starts breaking down
tables and preparing instruments for
Central Processing
Anesthesia move in and out of room
Instrument representative might leave
room and Visitors may leave room
22. Potential for Contamination of Sutures at
End of Case
Air settling plates in the operating room at
the last hour of a total joint case
Suture with Staphylococcus colonies
23. Plus Antibacterial Sutures:
Impact in a Real-World Setting
Plus sutures not only kill bacteria on the suture, but also create an
inhospitable environment around the suture
NEBH studied the “zone of inhibition” around the suture
A pure culture—0.5 MacFarland Broth—of S. aureus was
prepared on a culture plate
An antibacterial suture was aseptically cut, planted on the
culture plate, and incubated for 24 hrs
Traditional suture
Antimicrobial suture
23 5 day zone of inhibition 10 day zone of inhibition
24. Plus Antibacterial Sutures:
Impact in a Real-World Setting
NEBH One Year Prospective Study of 3800 Total Joints
and Antimicrobial Sutures
In July 2005, implemented a full-year evaluation of
antibacterial sutures usage in an orthopedic setting
Changed product over July 4th holiday and did not tell
all surgeons (only those involved with study)
At the end of the year-long trial period:
45% reduction in SSIs caused by Staph aureus and
MRSA
Infection rate dropped from 0.5
0.4
0.44% to 0.33% with three less infections 0.2 0.3
Series1
0.1
0
FY05 FY06
NAON Poster Presentation - 2010
24
Spencer M, et al: Reducing the Risk of Orthopedic Infections: The Role of Innovative Suture Technology
25. Articles Related To Antibacterial Sutures
*Justinger, C, et al. Antibiotic coating of abdominal closure
sutures and wound infection. Surgery 2009;145:330-4. (*RCT)
Rothenburger S, et al. In vitro antimicrobial evaluation of Coated
VICRYL* Plus Antibacterial Suture (coated polyglactin 910 with
triclosan) using zone of inhibition assays. Surg Infect 2002;3 Suppl 1:S79-
87
Ford HR, et al. Intraoperative handling and wound healing: controlled
clinical trial comparing coated VICRYL plus antibacterial suture (coated
polyglactin 910 suture with triclosan) with coated VICRYL suture (coated
polyglactin 910 suture). Surgical Infections. 6(3):313-21, 2005.
Edmiston CE, et al. Bacterial adherence to surgical sutures: can
antibacterial-coated sutures reduce the risk of microbial contamination?
Journal of the American College of Surgeons. 203(4):481-9, 2006 Oct
26. Innovative wound closure technologies
can address risk factors for SSIs
Topical Skin Adhesive provides a microbial barrier during the
critical wound healing period
SSI Risk Factor Innovative Technology
Bacterial colonization of the suture Antibacterial Sutures
Contamination of the incisional site after the Chlorhexidine/alcohol skin prep
wound is closed Prevention of Dehiscence and
Entry of bacteria from the skin during Exogenous Contamination with
wound closure Topical Skin Adhesive or
Bacterial infiltration due to dehiscence Antimicrobial Dressings
26
27. Antisepsis with Chlorhexidine
2% CHG/70% alcohol skin preparation
(tinted orange)
Has a lasting effect on the skin
~ 2 days postop
Iodophors are fast kill but no long term
effect
CHG dry time is 3 minutes (to prevent
fires)
• Evidence that chlorhexidine/alcohol achieves
better skin antisepsis than iodophor
Darouiche et al NEJM 2010
Ostrander et al JBJS Am 2005
Saltzman et al JBJS Am 2009
27
28. Post-op Skin Issues in Orthopedics
Anterior fusion with tape burns
Contaminated steri-strips
Posterior fusion with contaminated steri-strips Staples increase infection rate
29. Associated Wound Infection or Separation After
Cesarean Delivery: Sutures vs Staples
Prospective, randomized study of 435 c-section patients1
197 patients: staples
219 patients: 4-0 MONOCRYL™ (poliglecaprone 25) Suture on PS2 needle
– Wound separation rate: 17% (staples) vs. 5 % (sutures)
– Wound complication rate: 22% (staples) vs. 9% (sutures)
– Staple closure was a significant independent risk factor for wound
separation after adjustment for all other factors (GDM, BMI >30, incision
type, etc)
Meta-analysis of 6 studies with a total of 1487 c-section patients2
803 patients: staples
684 patients: subcuticular suture closure
– Staple closure was associated with a two-fold increase in risk of wound
infection or separation
1. Basha et al. Am J Obstet Gynecol. 2010;203:285.e1.
2. Tuuli et al. Obset Gynecol. 2011;117:682.
30. The risk for infection after joint surgery is higher with staples vs traditional
stitches, according to the results of a meta-analysis reported in the March
16 2010 issue of the BMJ.
In 6 publications reporting on a total of 683 wounds, 332 patients underwent
wound closure with sutures, and 351 underwent closure with staples.
Compared with suture closure, staple closure was associated with more
than triple the risk for the development of a superficial wound
infection after orthopaedic surgery (RR, 3.83; 95% CI, 1.38 – 10.68; P =
.01).
When hip surgery was analyzed as a separate subgroup, the risk for the
development of a wound infection was 4 times greater with use of
staples vs use of sutures (RR, 4.79, 95% CI, 1.24 – 18.47; P = .02). Suture
closure and staple closure did not differ significantly in development of
inflammation, discharge, dehiscence, necrosis, or allergic reaction.
“The Medical Journal of Australia” has recently updated its guidelines for skin
closure in the treatment of hip fractures, and they state that superficial wound
complication rates are higher for wounds closed with metallic staples than for
wounds closed with subcuticular vicryl.
31. Obesity and Surgical Incision
Incision collects fluid – serum,
blood - growth medium for
organisms
Spine fusions -incisions close to the
buttocks or neck
Heavy perspiration common
Body fluid contamination from
bedpans/commodes
Friction and sliding - skin tears and
blisters
Itchy skin - due to pain medications
- skin breakdown
31
32. Topical Skin Adhesive: A Proven Microbial
Barrier
Provides a flexible, protective microbial barrier that moves with the patient,
preventing breakage and acting like a temporary “skin”1,2
Adhesive demonstrates inhibition of gram-positive bacteria (MRSA and MRSE) and
gram-negative bacteria (E coli) in vitro2-4
Provides greater than 99% protection for 72 hours against organisms commonly
responsible for SSIs2,3:
S. epidermidis
E. coli
S. aureus
Pseudomonas aeruginosa
Enterococcus faecium
No fractures,
1. Quinn et al. JAMA. 1997;277:1527-1530 wound failure
2. Bhende et al. Surg Infect (Larchmt). 2002;3:251-257. or dehiscence
3. Narang et al. J Cutan Med Surg. 2003;7:13.
4. World Health Organization. WHO Guidelines for Safe Surgery 2009. 2009.
32
33. Topical Skin Adhesive: Benefits Beyond Risk
Reduction
For Hospital Staff
No time spent removing staples or sutures
Reduced hospitalization costs
Reduces number of suture set ups
Simplifies post-op wound checks
Reduces number of wound dressings
For Patients
7 days of wound healing strength in
less than 95 seconds of application
Shower immediately
Outstanding cosmesis
Reduced follow-up
Less pain and anxiety
33
35. Clinical Use of Incisionial Adhesive
Hip: Sealed with adhesive
covered with gauze and
transparent dressing for
incision protection
Knee: Sealed with incisional
adhesive, covered with Telfa
and a transparent dressing Healed incision
for incision protection
36. Incisional Adhesive and Total
Shoulder Replacements
Total Shoulder Rates
2.5
2
1.5
1
0.5
0
2003 2004 2005 2006 2007 2008 2009 2010
• Propionibacterium acnes related total shoulder infections (TSR)
• Eliminated the use of staples for TSR
• Instituted the use of incisional adhesive
• Covered dressing until day of discharge for protection
37. Selected Publications: DERMABOND® Topical
Skin Adhesive in Orthopedic Surgery
Procedure Reference No. of Patients Key Findings
• Patients followed for >7 months
Primary hip arthroplasty1 Khurana et al. 2008 93 • No infections
• 1 wound dehiscence
• Patients followed for >5 months
Lumbar and cervical spine 200
Hall and Bailes. 2005 • Only 1 documented SSI
procedures2 Retrospective
• High patient satisfaction
• Surgeon preference to reduce urinary
Total hip arthroplasty for Kregor et al. 2008 and fecal contamination of wound
Retrospective
femoral neck fracture3 and allow patients to shower
immediately
1. Khurana et al. Acta Orthop Belg. 2008;74:349.
2. Hall and Bailes. Neurosurgery. 2005;56(suppl 1):147.
3. Kregor et al. Techniques Ortho. 2008;23:312.
38. DERMABOND ADVANCED™ Topical Skin Adhesive
A protective barrier that adds strength and reduces bacteria
• Has been shown in ex vivo studies to have superior tensile strength versus other octyl
and butyl based products
• Creates a microbial barrier against organisms commonly responsible for SSIs *
Innovative
*Staphylococcus epidermidis, Staphylococcus aureus, Escherichia coli, Enterococcus faecium and Pseudomonas aeruginosa
Data on File. Ethicon, Inc.
39. Comparison of TSA Components Among Currently
Available Agents
DERMABOND
ADVANCED™
Topical Skin derma+flex® QS™ Histoacryl®
Components Adhesive SurgiSeal™ (octylseal™) INDERMIL® (Repara) LiquiBand® Skinstitch®
Octyl
adhesive
Plasticizers ?
Inert storage
vial,
stabilizer, and
no
refrigeration
Initiator and
heat-
dissipating
agent
High-
viscosity
formulation
The third-party trademarks used herein are trademarks of their respective owners.
Data on file: Ethicon Inc.
40. Evidence-Based Performance
The largest randomized clinical trial database of any TSA
8x the number of patients vs the leading competitor
Total Number Total Number of
Product of RCTs Patients Treated
DERMABOND®
40 4075
Topical Skin Adhesive
Histoacryl® 6 534
INDERMIL® 2 150
LiquiBand® 1 78
SurgiSeal® 0 0
derma+flex® QS™
0 0
(octylseal™)
No RCTs identified for any other competitors.
RCTs only; reasons for exclusion were language of publication other than German or English, nonhuman studies, case series or
case reports, and inappropriate indication.
The third-party trademarks used herein are trademarks of their respective owners.
RCT = randomized controlled trials.
Data on file: Ethicon Inc, Literature Search 2/2011 PubMed
41. New, innovative, minimally invasive
DERMABOND™ PRINEO™ Skin Closure System
A unique combination of
2 components
• A 2-octyl cyanoacrylate topical skin
adhesive for proven strength and
microbial protection1,2
– Sets in approximately 60 seconds
when applied to mesh
– 2-hour working time3
• A flexible, self-adhesive polyester mesh
for superior approximation and healing1,3
– Contains initiator that accelerates
polymerization of liquid adhesive
– Each dispenser contains 60 cm of tape
1. DERMABOND™ PRINEO™ IFU. PM72449C. STATUS 6/2010.
41 2. Shapiro AJ et al. Am Surg. 2001;67(11): 1113‐1115.
3. Data on file. Ethicon, Inc.
42. Minimally invasive closure that distributes tension
away from the wound
Traditional closure DERMABOND™ PRINEO™ Skin Closure
System
Gently and evenly disperses tension across the entire area
of the incision, without penetrating the skin
42
43. DERMABOND™ PRINEO™ removal
Patient is shown 2 weeks after circumferential body lift and immediately
after removal of
DERMABOND™ PRINEO™ Skin Closure System.
45. Surgical Incise Drapes
Iodophor- impregnated incise
barrier drape
No data to support these
drapes reduce SSI – although
do reduce bacteria on skin
Surgeon preference based on
adhesion to skin and drapes
Consider using non-
impregnated drapes and using
cost savings for other innovative
technologies
45
46. Use of plastic adhesive drapes during surgery
for preventing surgical site infection
Objective:
Compared the effect of adhesive drapes used during surgery on surgical site
infection, cost, mortality and morbidity
Five studies involving 3,082 participants comparing adhesive drapes with no
drape
Two studies involving 1,113 participants comparing iodine-impregnated
adhesive drapes with no drape
Conclusion:
A significantly higher proportion of patients in adhesive drape group
developed a surgical site infection when compared with no drape
Iodine-impregnated adhesive drapes had no effect on the surgical site
infection rate
Cochrane Database Syst Rev. 2007 Oct 17;(4):CD006353
47. Bacitracin/Polymixin Irrigation
Feb 2007 - stopped routine use of Bacitracin/Polymixin Irrigation
Cost: > $110,000/year reduced to $10,000
Limited use for revisions, allografts and infected cases (irrigation and
debridements)
New irrigant available – FDA approved for mucous membranes with
0.05% CHG - Irrisept
Fletcher N, et al: Prevention of perioperative infections. J Bone
Joint Surg Am. 2007;89:1605-1618
47
48. IRRISEPT
Finally, an alternative to saline and antimicrobial irrigation
The first and only FDA-cleared cleansing and debridement system, containing
0.05% Chlorhexidine Gluconate (CHG) in Water for Irrigation
IrriSept O.R. (sterile packaging)
Irrigation Applicators:
Custom designed
applicators facilitate
cleansing for a variety of
applications
SplatterGuard® LT SplatterGuard® IrriProbe®
48
49. Review: Bundled Approach to Eliminating SSIs
1. Pre-screen inpatient surgeries for MRSA and Staph aureus (MSSA) using PCR
rapid molecular technology
2. Decolonization protocol for MRSA/MSSA positive patients (eg mupirocin 2%
ointment 2 x day, daily CHG wash x 5 days)
3. Preoperative shower with CHG (eg Hibiclens) or CHG washcloths (eg Sage) night
before/morning of surgery
4. Assure OR standards are being met (traffic control, surgical attire, surgical hand
scrub, sterilized instruments, room turnover and terminal cleaning, precautions in
OR)
5. Assure surgical prophylaxis is delivered for maximum tissue concentrations
6. Surgical skin prep with CHG/alcohol prep
7. Irrigation with CHG if necessary (eg Irrisept)
8. Antibacterial sutures (eg Ethicon)
9. Incisional Adhesive (octyl cyanoacrylate) (eg Dermabond and Prineo)
10. Post-op incision care instructions
11. Data driven, analysis and calculation of rates, communication/feedback
50. Reducing Risk Factors for SSIs:
Tools for success
Institutional support
Senior leadership and “C Suite” involvement
“lead the effort” from top down
Clear goals
Structured program with clearly defined goal of
zero tolerance for HAIs
Theoretical foundation to IP Program: Social
Learning Theory (Role Modeling, Self Efficacy,
Positive Deviance)
Communication – effective and consistent
Ongoing and creative education
Financial support to Infection Prevention program
50