Prevention of Surgical Site Infection

Preventing Infection during Surgery is important. Standard Guidelines help team work on the same page. An update on various preventive strategy is discussed.

1. Update on prevention of SSI Dr Vaibhav Bagaria Joint Replacement Surgeon Sir HN Reliance Foundation Hospital Mumbai

2. Why is Important? 2nd only to UTI in terms of Nosocomial infections 2% of all hospitalised pts. ( 3 - 20%) Mortality - up to 3% pts die Morbidity Economic Burden Preventable

3. What am I doing here?

4. As a surgeon… It is a calling … We wear many hats!!! We are the face of both victory and defeat; Sound of happiness and cries of despair! We Reap what we Sow ( Literally & Figuratively)

5. Synopsis Definitions Risk Factors for developing SSI Microbiology Prevention of SSI General Measures Anti Microbial Prophylaxis Special Consideration regarding Staph Management of SSI

6. Definition Infection that occurs somewhere in the Op Field following Surgical Intervention CDC considers SSI to include both Incisional and Organ space SSI Incisional divided in Superficial and Deep Objective criteria developed by National Health Safety network ( NHSN) Ultimately Surgeon’s judgement in equivocal cases

7. Surgical Wound Class

8. Key Points Development of SSI depends on patient - related, procedure related and pathogen related factors It can be altered by application of evidence based prevention methods Causative Organism of SSI are predominantly the flora present at Incisional Site.

9. Risk Factors Patient Factors : Co-morbid Illness, Colonization with pathogenic bacteria, perioperative hyperglycaemia and Tobacco use Procedural factor : Breaks in Sterile Technique, Operating Room Ventilation and Traffic Proceduralist Factors : Surgical Technique, improper application of skin antisepsis and provider impairment

10. Patient Risk Factors

11. Procedural Factors

12. Proceduralist Factors

13. Prevention Practices to reduce bacterial inoculation into Wound Practices to improve host containment of introduced bacteria

14. Practices to reduce bacterial inoculation into Wound Anti septic Use Sterile Attire Decolonization Strategies Proper hair removal

15. Skin & Bacteria

16. Power of 1 Pathogenic Potential of a single bacterium to produce wound infection, provided that it is inoculated into a suitable niche.

17. Practices to improve host containment of introduced bacteria Maintenance of Normothermia Minimising tissue hypoxia Glucose control Anti microbial prophylaxis

18. Antimicrobial Prophylaxis Tissue Concentration of drug above MIC for common Flora Provide Right Drug: Target flora at the surgical site, penetrate surgical incision site and achieve minimum adverse event Provide Right Dose at Right Time Provide Right duration of drug

19. Prophylaxis

20. Newer delivery systems Antimicrobial washes Antibiotic cement Ab Coated sutures Intra operative Antibiotic sprays Antibiotic eluting Calcium Phosphate Brachytherapy Antibiotic Collagen Sponges

21. SSI Surveillance Standarized definitions Reduce variability in reported outcomes

22. Take Home Message

23. Thank You!!! # Hustle @RFH