1. Hygienic care of the patient before surgery BARN 3rd Workshop, 1-2 October 2012, Sweden Hospital of Lithuanian University of Health Sciences Kauno Klinikos Institute of Hygiene dr.G.Gailiene

2. Structure 21 buildings (area 123732,70 m 2 ) Number of profiled medical departments – 34 Subsidiaries – 4 (Oncology hospital, TB hospital, rehabilitation hospitals –child and adults) Total number of beds (with subsidiaries) – 2605 Total number of staff – 6229

3. Number of surgical procedures

4. Prevalence of HCAI in Hospital of Lithuanian University of Health Sciences Kauno Klinikos

5. Hospital of Lithuanian University of Health Sciences Kauno Klinikos 2012 Prevalence of HCAI according to site (%) in Hospital of Lithuanian University of Health Sciences Kauno Klinikos 2012

6. Prevalence of HCAI according to site in Lithuanian acute care hospitals (%) (Institute of Hygiene, 2010)

7. Prevalence of HCAI according to site in EU (%) (prevalence studies in EU counties 1990-2007)* http://www.ecdc.europa.eu/en/publications/Publications/0706_SUR_Annual_Epidemiol ogical_Report_2008.pdf *

8. Recommendations/guidelines Patient preparation for surgery procedure:  Country – recommendations;  Hospital – work instructions;

9. Methods Cross-sectional studies: Cross-sectional studies:  2009 -140 patients;  2012 – 66 patients; Departments:  13 surgery (excluding ENT, eye);  2 ICU: general (medical/surgery), cardiology;  3 therapy: cardiology, gastroenterology, nephrology.

10. Category IA - strongly recommended for implementation and supported by well- designed experimental, clinical, or epidemiological studies. If hair is removed, remove immediately before the operation, preferably with electric clippers. Category IA

11. Hair Removal

12. Method of hair removal Electric clippers – 0.0 %

13. Category IB - strongly recommended for implementation and supported by some experimental, clinical, or epidemiological studies & strong theoretical rationale. Require patients to shower or bathe with an antiseptic agent on at least the night before the operative day. Category IB

14. Patient shower or bath ( PH -patient hygiene)

15. Changing of patient clothes and bed linen 2009: 9 patients were bathed night before surgery, clothes and bed linen changed on surgery day; 8 patients were bathed, bed linen wasn’t changed. For 2 patients bed linen was changed night before surgery, bathed on the surgery day; 1 patient wasn’t bathed, bed linen changed on surgery day.

16. Category II - Suggested for implementation and supported by suggestive clinical or epidemiological or theoretical rationale Keep preoperative hospital stay as short as possible while allowing for adequate preoperative preparation of the patient. Category II Preoperative hospital stay (days) 2009 - 1.2 (0.7 – 2.6) 2012 – 1.1 (0.6 – 3.1)

17. Category IA - strongly recommended for implementation and supported by well- designed experimental, clinical, or epidemiological studies. Administer by the intravenous route the initial dose of prophylactic antimicrobial agent, timed such that a bactericidal concentration of the drug is established in serum and tissues when the incision is made... Category IA In 2009 and 2012 – 100, 0% patients received antimicrobial agent i/v ≤ 1 - 0 h before incision.

18. Summary Decreased cases of hair removal night before surgery (2009 - 5.7% vs. 2012 - 1.5%); Main method of hair removal remain shaving, clippers are not used; In 2012 all patients were bathed and was changed bed linen/clothes on surgery day; In general hygienic care of the patients before surgery improved, but SSI rate does not decreased.

19. Thank you for attention