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Preventing Surgical Site Infections (SSIs): What the Direct Caregiver Should Know Prepared by Ann Bailey, RNC, BSN, CIC Joanne Dixon, RN, MN, CIC December.

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Presentation on theme: "Preventing Surgical Site Infections (SSIs): What the Direct Caregiver Should Know Prepared by Ann Bailey, RNC, BSN, CIC Joanne Dixon, RN, MN, CIC December."— Presentation transcript:

1 Preventing Surgical Site Infections (SSIs): What the Direct Caregiver Should Know Prepared by Ann Bailey, RNC, BSN, CIC Joanne Dixon, RN, MN, CIC December 16, 2009

2 Objectives Upon completion of this module, the learner will be able to: Define Surgical Site Infection Name 4 factors that may influence the development of surgical site infections List 3 bundle components SFoH practices which decrease the risk of surgical site infections From CDCs NNIS

3 What Is a Surgical Site Infection? Infection at the site of surgery that occurs within 30 days of surgery if there is no implant (hardware, artificial graft, mesh, etc) OR occurs within 1 year of the surgery with an implant in place Types of SSIs: Superficial incisional Deep incisional Organ or body space From CDCs NNIS

4 Why Prevent SSIs? Approximately 500,000 surgical site infections (SSI) occur annually in the United States Patients that develop SSI have twice the mortality and are: 60% more likely to spend time in ICU 5 times more likely to be readmitted From CDCs NNIS

5 Why Prevent SSIs? SSI increases length of stay in hospital by an average of 7.5 days $2,734 to $26,019 extra cost per SSI (1985, US dollars) $130 million to $845 million per year estimated national costs in the USA From CDCs NNIS

6 Factors That may Influence SSI Development Patient Age Nutritional status Diabetes Smoking Obesity Coexistent infections at a remote body site Colonization with microorganisms Altered immune response Length of preoperative stay CDC Guideline for Prevention of Surgical Site Infections, 1999

7 Factors That may Influence SSI Development Operation Duration of surgical scrub Skin antisepsis Preoperative shaving Duration of operation Antimicrobial prophylaxis Operating room ventilation Inadequate sterilization of instruments Foreign material in the surgical site Surgical drains Surgical technique CDC Guideline for Prevention of Surgical Site Infections, 1999

8 What Are We Doing at SFOH to Prevent SSIs? Utilizing good surgical hand antisepsis & hand hygiene

9 What Are We Doing at SFOH to Prevent SSIs? Using a best practice bundle on all surgical patients Adapted from the Surgical Care Improvement Project (SCIP) Infection prevention components

10 Remember a Bundle is: A grouping of best practices that individually improve care, but when applied together result in substantially greater improvement. Science behind the bundle elements is well established – the standard of care. Bundle element compliance can be measured as yes/no. All or none approach.

11 Surgical Site Infection Prevention Bundle Components 1.Prophylactic antibiotic given within one hour prior to surgical incision 2.Prophylactic antibiotic selection for surgical patients 3.Prophylactic antibiotics discontinued within 24 hours after surgery end time (48 hours for cardiac surgery) 4.Cardiac surgery patients with controlled 6 A.M. postoperative serum blood glucose

12 Surgical Site Infection Prevention Bundle Components 5.Surgery patients with appropriate hair removal 6. Surgery Patients with Perioperative Temperature Management - maintaining normothermia 7. Urinary Catheter Removal on Postoperative Day 1 or 2 with day of surgery being day zero.

13 Surgical Site Infection Prevention Bundle Components 1.Prophylactic antibiotic given within one hour prior to surgical incision -The goal of prophylaxis with antibiotics is to establish bactericidal tissue and serum levels at the time of incision. Rationale: …reduce the microbial burden of intraoperative contamination to a level that cannot overwhelm host defenses.* *CDC Guideline for Prevention of Surgical Site Infections, 1999

14 Surgical Site Infection Prevention Bundle Components 2.Prophylactic antibiotic selection for surgical patients Surgical patients who received prophylactic antibiotics consistent with current guidelines (specific to each type of surgical procedure) have fewer surgical site infections Rationale: Use an AMP (surgical antimicrobial prophylaxis) for all operations or classes of operations in which its use has been shown to reduce SSI rates based on evidence from clinical trials…* *CDC Guideline for Prevention of Surgical Site Infections, 1999

15 Surgical Site Infection Prevention Bundle Components 3.Prophylactic antibiotics discontinued within 24 hours after surgery end time Rationale: Short duration antibiotics are as effective in preventing infection as long duration antibiotics Long duration antibiotics are more likely to cause development of drug resistant bacteria

16 Surgical Site Infection Prevention Bundle Components 4.Cardiac surgery patients with controlled postoperative blood glucose Rationale: Hyperglycemia has been associated with increased in-hospital morbidity and mortality for multiple medical and surgical conditions. -Risk of infection is significantly higher for patients undergoing CABG if blood glucoses are elevated. -Deep wound infections in diabetic patients undergoing cardiac surgery is reduced by controlling blood glucose levels < 200 mg/dL in the immediate postoperative period.

17 Surgical Site Infection Prevention Bundle Components 5.Surgery patients with appropriate hair removal Hair removal, if indicated should be accomplished with clippers rather than razors or depilatories. Rationale: Razor shaving has been associated with increased SSIs attributed to microscopic cuts in the skin that serve as foci for bacterial multiplication* *CDC Guideline for Prevention of Surgical Site Infections, 1999

18 Surgical Site Infection Prevention Bundle Components 6.Surgery Patients with Perioperative Temperature Management - Maintaining normothermia Surgery patients for whom either active warming was used intraoperatively for the purpose of maintaining normothermia or who had at least one body temperature 96.8 o F/36 o C recorded within the 30 minutes prior to or the 15 minutes immediately after anesthesia end time. Rationale: Hypothermia (<36 o C) increases the risk for surgical site infection *CDC Guideline for Prevention of Surgical Site Infections, 1999

19 Surgical Site Infection Prevention Bundle Components 7.Urinary Catheter Removal on Postoperative Day 1 or 2 with day of surgery being day zero. Rationale: Removing the indwelling urinary catheter decreases risk of urinary tract infection and associated complication of bacteremia that could lead to increased length of stay, more frequent readmissions and increased morbidity and mortality *CDC Guideline for Prevention of Surgical Site Infections, 1999

20 Other SSI Prevention Measures* Encourage patient tobacco cessation prior to surgery Ask patients to shower or bathe with antiseptic agent on at least the night before the operative day *CDC Guideline for Prevention of Surgical Site Infections, 1999

21 Other SSI Prevention Measures* Ill surgical staff refrain from working Surgical team keeps nails short and does not wear artificial nails Surgical team performs appropriate hand/forearm antisepsis prior to surgery *CDC Guideline for Prevention of Surgical Site Infections, 1999

22 Other SSI Prevention Measures* Surgical team wears appropriate surgical attire Uses proper aseptic and surgical technique during procedures Use appropriate antiseptic agent for skin prep *CDC Guideline for Prevention of Surgical Site Infections, 1999

23 Other SSI Prevention Measures* Protect closed incision with sterile dressing for hours postoperatively Maintain adequate/recommended ventilation processes in the operating rooms *CDC Guideline for Prevention of Surgical Site Infections, 1999

24 Other SSI Prevention Measures* Perform adequate cleaning and disinfection of environmental surfaces in the surgery areas Sterilize all surgical instruments according to published guidelines *CDC Guideline for Prevention of Surgical Site Infections, 1999

25 Your Role Follow the bundle components specific to your role in the patients care Provide appropriate/indicated patient teaching regarding these bundle component and other recommended practices Document patient education related to the goal of SSI prevention Patient education materials related to SSI prevention can be found on the Intranet: Remind peers of the importance of following the recommended practices if they are observed to be non- compliant

26 Questions? Contact the Infection Preventionist at your site

27 References Measurement/PerformanceMeasurement/SCIP +Core+Measure+Set.htmhttp://www.jointcommission.org/Performance Measurement/PerformanceMeasurement/SCIP +Core+Measure+Set.htm te.htmlhttp://www.cdc.gov/ncidod/dhqp/gl_surgicalsi te.html urgicalSiteInfections/


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