Surgical site infection& amp dr. anil ganju

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Surgical site infection& amp dr. anil ganju

  1. 1. Surgical site infections & AMP Dr. Anil Ganju
  2. 2. Surgical Site Infections (SSI) Def: Infections that occur in the wound created by an invasive surgical procedure .  Most important causes of HCAIs. (14-16% )  Most common surgical patient nosocomial infection (38%)  Over 1/3rd of postoperative deaths are related to SSI.  Deaths in patients with nosocomial infections—77% related to infection.  2/3 involved surgical incision, 1/3 deep structures accessed by incision
  3. 3. SSIs, Soft tissue/wound infections  Range from a relatively trivial wound discharge with no other complications to a life-threatening condition.  Considerable morbidity poor scars that are  cosmetically unacceptable,  hypertrophic or keloid,  persistent pain and itching,  restriction of movement,  impact on emotional wellbeing  SSI can double the length of time a patient stays in hospital and thereby increase the costs.
  4. 4. SSI – Surgery Classification 1. Clean Surgeries 2. Clean contaminated 3. Contaminated 4. Dirty infected
  5. 5. SSI – Wound Classification Class 1 = Clean Class 2 = Clean contaminated Class 3 = Contaminated Class 4 = Dirty infected
  6. 6. Class I (clean) Atraumatic wound w/o inflammation. No respiratory, GU,GI,or biliary tract entered e.g-Hernia repair 1.5% infection rate
  7. 7. Class II(clean/contaminated) entrance into respiratory, GU,GI,or biliary tracts e.g.- Cholecytectomy, elective bowel resection ? infection rate
  8. 8. Class II(clean/contaminated) Controlled entrance into respiratory, GU,GI,or biliary tracts Cholecytectomy, elective bowel resection 7.5% infection rate
  9. 9. Class III(contaminated) Traumatic wounds, major breaks in sterile techniques, gross spillage of GI contents, Acute non-purulent inflammation e.g.- Appendectomy ? infection rate
  10. 10. Class III(contaminated) Traumatic wounds, major breaks in sterile techniques, gross spillage of GI contents, Acute non-purulent inflammation Appendectomy 15% infection rate
  11. 11. Class IV (dirty) Old trauma wounds; devitalized tissue; existing clinical infection, perforated viscera. e.g.- Hartmann’s for diverticular perforation ? Infection rate
  12. 12. Class IV (dirty) Old trauma wounds; devitalized tissue; existing clinical infection, perforated viscera. Hartmann’s for diverticular perforation 40% infection
  13. 13. Extend of Incisional SSI Superficial Surgical Site Infection Deep Surgical Site Infection Organ/Space Surgical Site Infection
  14. 14. Risk of Infection(Pathogenesis) Bacterial dose Virulence Impaired host resistance
  15. 15. Transmission Cycle in OT Infectious agents bacteria,virus ,etc. Susceptible Hosts (clients, service providers, commu. members, Ancillary staffs) Reservoirs people,water,air, Instruments Places of exit Resp.,GU,GI Modes of transmission Contact, droplet, ai rborne, vehicle Place of entry broken skin, surgical site, mucous membrane
  16. 16. SSI – Risk Factors Operation Factors  Duration of surgical scrub  Maintain body temp.  Skin antisepsis  Pre-operative shaving  Duration of operation  Antimicrobial prophylaxis  Operating room ventilation  Inadequate sterilization of instruments  Foreign material at surgical site  Surgical drains  Surgical technique Poor hemostasis Failure to obliterate dead space Tissue trauma
  17. 17. Opportunity to Prevent SSI An estimated 40%–60% of SSIs are preventable. Overuse, underuse, improper timing, and misuse of antibiotics occurs in 25%–50% of operations.
  18. 18. Four main strategies: Prevent infection,  diagnose and treat infection  use antimicrobials wisely, and  prevent transmission.
  19. 19. Antimicrobial prophylaxis Def.: Surgical antimicrobial prophylaxis (AMP) refers to a brief course of an antimicrobial agent just before an operation begins. AMP is not an attempt to sterilize tissues, but a critically timed use to reduce the microbial burden of intraoperative contamination to a level that cannot overwhelm host defenses. AMP does not pertain to prevention of SSI caused by postoperative contamination. Intravenous infusion is the mode of AMP delivery in modern surgical practice. Essentially all confirmed AMP indications pertain to elective operations in which skin incisions are closed in the operating room.
  20. 20. Antimicrobial prophylaxis Four principles to maximize the benefits of AMP:  Use an AMP agent for all operations or classes of operations in which its use has been shown to reduce SSI rates or for those operations after which incisional or organ/space SSI would represent a catastrophe.  Use an AMP agent that is safe, inexpensive, and bactericidal that covers the most probable intraoperative contaminants for the operation.  Time the infusion of the initial dose of antimicrobial agent so that a bactericidal concentration is established in serum and tissues by the time of skin incised.  Maintain therapeutic levels of the antimicrobial agent in both serum and tissues throughout the operation and until, at most, a few hours after the incision is closed in the operating room.
  21. 21. SSI – Wound/Surgery Classification • Class 1 = Clean • Class 2 = Clean contaminated • Class 3 = Contaminated • Class 4 = Dirty infected . Prophylactic antibiotics indicated Therapeutic antibiotics
  22. 22. AMP indications for clean operations Two well-recognized indications for such clean operations are: (1) when any intravascular prosthetic material or a prosthetic joint will be inserted, and (2) for any operation in which an incisional or organ/space SSI would pose catastrophic risk. Examples are all cardiac operations, including cardiac pacemaker placement, vascular operations involving prosthetic arterial graft placement at any site or the revascularization of the lower extremity, and most neurosurgical operations Some have advocated use of AMP during all operations on the Breast.

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