Undergraduate level presentation on Prevention of Surgical infection covering the topics of:
History
Definition
Classification
Risk factors
Surgical Site Infection (SSI)
Tetanus
Gas gangrene
Preventing Infection during Surgery is important. Standard Guidelines help team work on the same page. An update on various preventive strategy is discussed.
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.
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
A discussion on the risk factors, classification and clinical presentation of surgical site infection. Also elucidates the overview of management approach to SSI.
Undergraduate level presentation on Prevention of Surgical infection covering the topics of:
History
Definition
Classification
Risk factors
Surgical Site Infection (SSI)
Tetanus
Gas gangrene
Preventing Infection during Surgery is important. Standard Guidelines help team work on the same page. An update on various preventive strategy is discussed.
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.
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
A discussion on the risk factors, classification and clinical presentation of surgical site infection. Also elucidates the overview of management approach to SSI.
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
ICMR guidelines on antimicrobial use in Sepsis and SSI's in Indiasanyal1981
Sepsis, septic shock, sepsis induced hypotension, SIRS, common pathogens, trends of antimicrobial resistance. Emperical antibiotic therapy, Classification of surgical site infections with specifications regarding site specific pathogens and peri-operative prophylaxis
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
2. WHY THIS TOPIC?
SSI is MOST COMMON hospital acquired infection in
surgical patients.
3rd most common hospital acquired infection.
Preventable
Prolong the hospital stay (7.3
days) Expenditure
Over one-third of postoperative deaths
Poor scar, persistent pain and itching, restriction of movement
an
d
5. ALEXANDER FLEMING
5
• The discovery of the antibiotic penicillin is
attributed to Alexander Fleming in 1928, but it
was not isolated for clinical use until 1941 by
Florey and Chain.
• Since then, there has been a proliferation of
antibiotics with broad-spectrum activity and
antibiotics today remain the mainstay of
antimicrobial therapy.
Ref: Bailey & Love’s Short Practice of Surgery, 27th Edition.
6. WHAT IS SSI?
Surgical site infections
(SSIs) are infections of
the tissues, organs, or
spaces exposed by
surgeons during
performance of an
invasive procedure.
9. SUPERFICIAL INCISIONAL
SURGICAL SITE
INFECTIONS
Infection occurs within 30 days of procedure
Involve skin or subcutaneous tissue
At least one of the followings:
• purulent drainage +/-
• organisms isolated aseptically from fluid or tissue of superficial incision
• Superficial incision that is deliberately opened by the surgeon & is culture positive
or not cultured
• Patient has one of the followings signs/symptoms(pain/tenderness,localised
swelling,redness,temparature
11. DEEP INCISIONAL SURGICAL SITE
INFECTIONS
• Infection occur within 30 days of procedure (or one
year in the case of implants)
• Involve deep soft tissues, such as the fascia and
muscles.
At least one of the followings:
• purulent drainage from deep incision, signs of infection
• spontaneously dehisces or opened by surgeon & is culture
positive or not cultured
• Fever >38 degree c,localized pain or tenderness
• an abscess or other evidence of infection found on direct
exam,during invasive procedure,by HPE,by imaging test
• Diagnosis of deep ssi by surgeon or attending physician
13. ORGAN OR SPACE SURGICAL SITE
INFECTION
30 days no implant or 1 year with implant
Any part is involved which was opened or manipulated
other than the incision
At least one of the followings:
• purulent drainage from deep incision, signs of infection
• Organism isolated from an aseptically obtained culture of fluid
or tissue in the organ/space
• an abscess or other evidence of infection found on direct
exam,during invasive procedure,by HPE,by imaging test
• Diagnosis of deep ssi by surgeon or attending physician
15. Earl
y
• Infection
presents
within 30
days of
procedure
Intermediat
e
• Occurs
between
one and
three
months
Lat
e
• Presents
more than
three
months after
surgery
According
to time
16. According to
MINOR
• Wound infection is
described as minor
when there is
discharge without
cellulitis or deep
tissue destruction
MAJO
R
• When there is pus
discharge with tissue
breakdown , Partial
or total dehiscence
of the deep fascial
layers of wound or if
systemic illness is
present.
17. The risk is also
microorganism
related to the amount of contamination with
s which is called “class” of the operation
Surgical wounds
classification
DEFINITION
• Ref:CDC
Clea
n
Operations in which no inflammation is encountered and the
respiratory, alimentary or genitourinary tracts are not entered.
There is no break in aseptic operating theatre
technique.eg:hernioplasty,thyroidectomy,surgeries of
brain,joints,heart & transplant.
Clean-
contaminated
Operations in which the respiratory, alimentary or genitourinary
tracts are entered but without significant
spillage.Eg:appendectomy,GJ,pancratic & biliary surgery
Contaminate
d
Operations where acute inflammation (without pus) is
encountered, or where there is visible contamination of the
wound. Examples include gross spillage from a hollow viscus
during the operation or compound/open injuries operated on
within four hours
Dirty
Operations in the presence of pus, where there is a previously
perforated hollow viscus, or compound/open injuries more than
four hours old.Eg:Abscess,perforated viscous with peritonitis,fecal
contamination
21. SEPSIS 3.0
• Ref: INTERNATIONAL GUIDELINES FOR MANAGEMENT
OF SEPSIS & SEPTIC SHOCK,2016
SEPSIS 2(OLD)
22. PATHOGENESIS OF SURGICAL SITE
INFECTION
Contamina
ti
on
• Endogeno
us
infection
• Exogeno
us
infection
• Haematogen
o us spread
• Staph
aureu
s
• Enterobact
e riaceae
and
anaerobes
Proliferatio
n
of bacteria
Induce
inflammatio
n
– signs
appear
Identified
or
unidentifie
d
Self
resolving
-> resolve
by
treatment -
> sepsis
and death
25. Local factors
• Poor skin preparation
• Contamination of instruments
• Inadequate antibiotic
prophylaxis
• Prolonged procedure
• Site and complexity of
procedure
• Local tissue necrosis
• Hypoxia
29. PRE OPERATIVE
PHASE
• Pre op Shower
– With
soap(CHLORHEXI
DINE SOAP)
– Day before or on
thev day of
surgery(8-12 hrs
prior)
• Nasal
decontamination:
Consider nasal
mupirocin
Ref:NICE Guideline on Prevention and treatment of surgical site infection,
(National
30. PRE OPERATIVE
PHASE
• Shaving:
• Limited to the area of surgery
• Day of surgery
– Disposable razor
– Depilation cream
– Electric clippers with single use Clipping
Ref:NICE Guideline on
Prevention and treatment of
surgical site infection,
(National
Institute for Health and
Clinical Excellence, 2018-
31. PRE-OPERATIVE
SHAVING/HAIR REMOVAL
Method of hair
removal Razor =
5.6% SSIrates
Depilatory = 0.6% SSI rates
Timing of hair removal
Shaving immediately
before Shaving 24
hours before Shaving
>24 hours before
= 3.1% SSI
rates
= 7.1% SSI
rates
= 20% SSI 29
Ref:CDC
33. PRE OPERATIVE PHASE
Patient theatre wear:
Give patients specific theatre wear that is appropriate for the
procedure and clinical setting, and that provides easy access
to the operative site and areas for placing devices, such as
intravenous cannulas. Take into account the patient's
comfort and dignity
Ref:NICE Guideline on Prevention and treatment of surgical site
infection, (National
Institute for Health and Clinical Excellence, 2018-19.)
34. PRE OPERATIVE
PHASE
• Theatre staff’S
Dress
– Non-Sterile&
clean
• Cap & Mask
• Shoes
• Goggles
• Staff leaving the
operating area:
minimum movements
in & out of the
operating area
Ref:NICE Guideline on Prevention and treatment of surgical site
infection, (National
Institute for Health and Clinical Excellence, 2018-19.)
35. PRE OPERATIVE
PHASE
• Mechanical bowel
preparation:
– Do not use mechanical
bowel preparation to
reduce ssi
• Hand jewellery, artificial
nails & polish
The operating team
should remove hand
jewellery or artificial
nails or polish
Ref:NICE Guideline on Prevention and treatment of surgical site
infection, (National
Institute for Health and Clinical Excellence, 2018-19.)
36. PRE OPERATIVE
PHASE
• Hand washing
– Betadine/Chlorhexidi
ne
– No need for
soap/brush
– 5 minute ritual
– 2 minute between
cases/hand scrub
37. PRE OPERATIVE
PHASE
• Antibiotic prophylaxis
– 1 hour before incision
• Before incision!
• Additional dose:
–if prolonged operation
Ref:NICE Guideline on Prevention and treatment of surgical site
infection, (National
Institute for Health and Clinical Excellence, 2018-19.)
38. ANTIBIOTIC PROPHYLAXIS
• Give antibiotic prophylaxis to patients before:
– clean surgery involving the placement of a prosthesis or
implant
– clean-contaminated surgery
– contaminated surgery.
• Do not use antibiotic prophylaxis routinely for clean
non- prosthetic uncomplicated surgery.
• Use the local antibiotic formulary and always consider
potential adverse effects when choosing specific
antibiotics for prophylaxis.
• Consider giving a single dose of antibiotic
prophylaxis intravenously on starting
anaesthesia.
• For operations in which a tourniquet is used
give prophylaxis earlier
Ref:NICE Guideline on Prevention and treatment of surgical site infection,
36
40. IMPORTANCE OF TIMING OF
SURGICAL ANTIMICROBIAL
PROPHYLAXIS (AP)
• Prospective study of 2,847 elective clean
and clean-contaminated procedures
• Early AP (2-24 hrs before
incision):
• Postop AP (3-24 hrs after
incision):
• Periop AP (< 3 hrs after
3.8
%
3.3
%
1.4
Ref:CDC
41. INTRA OPERATIVE
PHASE
• Sterile Gown &
Gloves
– Water resistant gowns
– Double glove
technique
Ref:NICE Guideline on Prevention and treatment of surgical site
infection, (National
Institute for Health and Clinical Excellence, 2018-19.)
42. INTRA OPERATIVE
PHASE
• Patient skin
Preparation
– Iodine/Chlorhexidine
– Allow it to dry & avoid
spillage to diathermy pad
Ref:NICE Guideline on Prevention and treatment of surgical site
infection, (National
Institute for Health and Clinical Excellence, 2018-19.)
43. INTRA OPERATIVE
PHASE
• Incision drapes
– Use iodophor impregnated sticky
drapes unless the patient has an
iodine allergy
Ref:NICE Guideline on Prevention and treatment of surgical site
infection, (National
Institute for Health and Clinical Excellence, 2018-19.)
44. INTRA OPERATIVE
PHASE
• Diathermy
– Don’t use diathermy for surgical
incision to reduce SSI
Ref:NICE Guideline on Prevention and treatment of surgical site
infection, (National
Institute for Health and Clinical Excellence, 2018-19.)
45. INTRA OPERATIVE
PHASE
• Patient Homeostasis
– Avoid Hypothermia
• Warm fluids for infusion and for lavage
• Warm blankets
• Warm mattress
• Monitor temperature every 30 min during surgery and post
op
– Avoid Hypoxia
• Post operative mask O2 / monitor Spo2
– Avoid hypotension
• Infuse adequate fluids
Ref:NICE Guideline on Prevention and treatment of surgical site
infection, (National
Institute for Health and Clinical Excellence, 2018-19.)
46. INTRA OPERATIVE
PHASE
• Theatre discipline
– Sterile & Quiet environment
– Avoid to & fro movement
– Ensure sterility of equipments &
Theatre
– Laminar airflow/Filters
Ref:NICE Guideline on Prevention and treatment of surgical site
infection, (National
Institute for Health and Clinical Excellence, 2018-19.)
47. PARAMETERS FOR OPERATING ROOM
VENTILATION
• Temperature:68o-73oF, depending on
normal ambient temp
30%-60%
from “clean to less
clean”
• Relative
humidity:
• Air
movement:
areas
• Air changes:
>15 total per hour
>3 outdoor air per
hour
Ref:American Institute of Architects
49. INTRA OPERATIVE PHASE
• Wound irrigation &
intracavitary lavage:
Don’t give to reduce ssi
• Antiseptics & antibiotics
before wound closure:
Under clinical research trial
Ref:NICE Guideline on Prevention and treatment of surgical site
infection, (National
Institute for Health and Clinical Excellence, 2018-19.)
50. INTRA OPERATIVE PHASE
• Wounds closure methods:
Consider using sutures
rather than staplers to
reduce the superficial
wound dehiscence
Consider using triclosan-
coated suture especially in
pediatric surgery to reduce
ssi
Ref:NICE Guideline on Prevention and treatment of surgical site
infection, (National
Institute for Health and Clinical Excellence, 2018-19.)
51. INTRA OPERATIVE PHASE
• Wound dressing:
Cover surgical incisions with
appropriate interactive
dressings at the end of
operation
Ref:NICE Guideline on Prevention and treatment of surgical site
infection, (National
Institute for Health and Clinical Excellence, 2018-19.)
52. POST-OPERATIVEMEASURES
52
• Changing dressings
– Use an aseptic non-touch technique for
changing or removing surgical wound
dressings.
• Postoperative cleansing
– Use sterile saline for wound cleansing up to 48 hours
after
surgery.
– Advise patients that they may shower safely 48 hours
after surgery.
– Use tap water for wound cleansing after 48 hrs if the
surgical wound has separated or has been opened
surgically to drain pus
Ref:NICE Guideline on Prevention and treatment of surgical site
infection, (National
Institute for Health and Clinical Excellence, 2018-19.)
53. POST-OPERATIVEMEASURES
53
• DON’T use Topical antimicrobial agents for
wound healing by primary intention
• Dressings for wound healing by
secondary intention
– Do not use Eusol and gauze, or moist cotton
gauze or mercuric antiseptic solutions.
– Use an appropriate interactive dressing.
Ref:NICE Guideline on Prevention and treatment of surgical site
infection, (National
Institute for Health and Clinical Excellence, 2018-19.)
54. POST-OPERATIVE MEASURES
• Antibiotic treatment of surgical site
infection and treatment failure
– When surgical site infection is suspected (i.e.
cellulitis), either de novo or because of
treatment failure,
– give the patient an empirical antibiotic that
covers the likely causative organisms.
• Debridement:
Don’t use eusol/gauze or enzymatic
treatments for debridement to
reduce ssi
Ref:NICE Guideline on Prevention and treatment of surgical site infection,
(National
55.
56. MANAGEMENT OF SSI
• Surveillance
• Drainage of pus
– Culture and
sensitivity
• MRSA
• VRE
• ESBL strains
• Debridement
• Antibiotics
• Removal of Implant
58. MANAGEMENT OF INCISIONAL SURGICAL SITE
INFECTION
• Removal of sutures with drainage of pus
• Pus sent for c/s
• Debridement and open wound care
• Delayed primary or secondary suture
once wound shows signs of healing by
healthy granulation tissue
59. TAKE HOME MESSAGE
TYPES OF SSI
SEPSIS 3.O
NICE GUIDELINES FOR PREVENTION OF
SSI
MEASURES TAKEN
ANTIBIOTIC PROPHYLAXIS
MANAGEMENT OF SSI
61. References:
• Bailey & Love’s Short Practice of Surgery, 27th Edition
• Sabiston Textbook of Surgery
• NICE guidelines of SSI
• WHO guidelines of SSI
• SRB manual of Surgery,6th ed