SSI infection control prevention bundle.pptx

all surgical operation must fallow the bundle

1. Surgical site infection prevention

2. Background Surgical site infections Are the most common nosocomial infections in the surgical patient Are the most common colorectal abdominal surgery complications (3–30%) Are associated with increased length of stay, readmission, and mortality Cost, depending on infection location, $ 6,200–$15,000 per patient (superficial vs. organ space)

3. SSI Definitions Superficial Purulent drainage from wound Positive wound culture Pain, redness, swelling Diagnosis by surgeon Organ Space Infection in the surgical cavity (abdomen) Deep Purulent drainage from deep aspect of the wound Dehiscence Abscess on exam or CT scan

4. WHAT IS A BUNDLE ????? A bundle is a group of procedures based on best practices When applied together can reduce incidence of HAIs

5. SSI bundle of prevention Screening of patient preoperative for MRSA Antimicrobial prophylaxis Skin preparation and hair removal Controlling blood glucose level in diabetic patients Controlling body temperature

6. Screening of patient preoperative for MRSA 1.  Kil EH, Heymann WR, Weinberg JM. Methicillin-resistant Staphylococcus aureus: an update for the dermatologist, Part 1: Epidemiology. Cutis. 2008 Mar;81(3):227–33.  [ PubMed ]  2 . Boucher HW, Corey GR. Epidemiology of methicillin-resistant staphylococcus aureus.  Clin Infect Dis. 2008;46(( Suppl 5)):S344–S349.  [ PubMed ] 

7. Decolonization MRSA screening of patient for MRSA colonization in some cases Contact isolation Preoperative decolonization: Mupircin intranasal ointment 2% Q12 for 5 days Antiseptic bathing with chlorhexidine 4% or betadin 7.5% for 5 days

8. Antimicrobial prophylaxis 1.AlBuhairan B, Hind D, Hutchinson A. Antibiotic prophylaxis for wound infections in total joint arthroplasty: a systematic review. J Bone Joint Surg Br. 2008 Jul;90(7):915-9. [ PubMed ] 2.Tarchini G, Liau KH, Solomkin JS. Antimicrobial Stewardship in Surgery: Challenges and Opportunities.  Clin Infect Dis. 2017 May 15;64(suppl_2):S112-S114. [ PubMed ]

9. The goal for timing of antibiotic administration to have the concentration in the tissues at its highest at the start and during surgery.   standardized administration should occur within 1 hour of skin incision and continue 24 hours postoperatively. Furthermore, surgical durations of greater than 4 hours or estimated blood loss over 1,500 mL repeat intraoperative dosing of antibiotics Clinical practice guidelines for antimicrobial prophylaxis in surgery. American Journal of Health-System Pharmacy. 2013 Feb 1;70(3):195-283. PMID: 23327981. http://www.ashp.org/surgical-guidelines

10. Cefazolin is used most often for surgical prophylaxis in patients with no history of beta-lactam allergy Patient with MRSA colonization/ infection ( cefazolin + clindamycin or vancomycin ) Cefazolin: 2 g (3 g for weight >120 kg) Vancomycin: 15 mg/kg  

11. Controlling blood glucose level 1.  World Health Organization  Global Guidelines for the Prevention of Surgical Site Infection.  [2018 Feb 23]. (WHO) Available from:  www.who.int . 2.  Le Guillou V, Tavolacci MP, Baste JM, Hubscher C, Bedoit E, Bessou JP, et al. Surgical site infection after central venous catheter related infection in cardiac surgery. Analysis of a cohort of 7557 patients.  J Hosp Infect.  2011;79(3):236–241 . ]

12. Perioperative hyperglycemia is reported in 20-40% of patients undergoing general surgery  and approximately 80% of patients after cardiac surgery .  A recent report examining point-of-care glucose testing in 3 million patients, across 575 American hospitals, reported a prevalence of hyperglycemia (BG >180 mg/dl, 10 mmol /l) as 32% in both intensive care (ICU) patients and non-ICU patients .   12-30 % of patients who experience intra and/or post-operative hyperglycemia do not have a history of diabetes before surgery ,  a state often described as stress hyperglycemia .  Stress hyperglycemia typically resolves as the acute illness or surgical stress abates.

13. Controlling blood glucose Preoperative preparation: many guidelines have provided recommendations on the preoperative HbA1c level for achieving better surgical outcomes, recommended that the HbA1c level should be  below 7% or 6.5% For open heart surgery patient accepted level at 8.5% or 8%-9% day of surgery admission planned for the day of surgery manage hypo‐ and hyperglycemia. Surgery should be scheduled at the start of the theatre list to minimize disruption to the patient's glycemic control.

14. Skin preparation Hair removal was carried out immediately before surgery in five studies ( Balthazar 1983 ;  Grober 2013 ;  Ilankovan 1992 ;  Kowalski 2016 ;  Nascimento 1991 ), the morning of surgery in one study ( Sun 2014 ); and on the day of surgery in three studies ( Adisa 2011 ;  Suvera 2013 ;  Taylor 2005 ). Hair was removed the day before surgery in three studies ( Goëau‐Brissonnière 1987 ;  Lu 2002 ;  Thorup 1985 ).  Thur de Koos 1983  removed hair with a razor immediately before surgery and used cream the evening before.  Powis 1976  allowed hair to be removed the day of surgery or the day before depending on the surgeon's preference, and  Court‐Brown 1981  and  Ko 1992  shaved the evening before for participants having elective (scheduled) surgery, and the day of surgery for participants having emergency (unscheduled) surgery .

15. Hair has not been removed if at all possible, hair removal by clipping not shaving on the day of surgery Hair removal by cream is accepted Patient shower after hair removal Hair remova l

16. Normotherima of patient Hair removal was carried out immediately before surgery in five studies ( Balthazar 1983 ;  Grober 2013 ;  Ilankovan 1992 ;  Kowalski 2016 ;  Nascimento 1991 ), the morning of surgery in one study ( Sun 2014 ); and on the day of surgery in three studies ( Adisa 2011 ;  Suvera 2013 ;  Taylor 2005 ). Hair was removed the day before surgery in three studies ( Goëau‐Brissonnière 1987 ;  Lu 2002 ;  Thorup 1985 ).  Thur de Koos 1983  removed hair with a razor immediately before surgery and used cream the evening before.  Powis 1976  allowed hair to be removed the day of surgery or the day before depending on the surgeon's preference, and  Court‐Brown 1981  and  Ko 1992  shaved the evening before for participants having elective (scheduled) surgery, and the day of surgery for participants having emergency (unscheduled) surgery.

17. Keep the patient warm Patient must be kept warm pre and during and post operative Normo-thermia of the patient postoperative The patient temperature must be above 36

18. References Wick EC, Hobson DB, Bennett JL, et al. Implementation of a surgical comprehensive unit-based safety program to reduce surgical site infections.  JACS  2012; 215(2):193-200. PMID: 22632912. National Healthcare Safety Network. CDC/NSHN Surveillance definitions for specific types of infections. In: NSHN Patient Safety Component Manual. Atlanta: Centers for Disease Control and Prevention; January  2014:chapter 17.  www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_curren t.pdf . Accessed June 11, 2014. Centers for Medicare & Medicaid Services. Hospital Compare.  www.medicare.gov/hospitalcompareprofile.html#profTab=2&ID=210009&loc=21287&lat=39.2962372&lng=-76.5928888&name=johns%20hopkins%20hospital . Accessed May 30, 2010

19. Ways To Identify Defects at you hospital Perioperative Staff Safety Assessment (PSSA) SSI Investigation tool Auditing tools Glucose control audit tool Normothermia audit tool Skin preparation audit tool Antibiotic audit tool Tip : These tools can be found on the AHRQ W eb site at https ://www.ahrq.gov/professionals/quality-patient-safety/hais/tools/surgery/materials.html Select “Supplemental tools” under “Applying CUSP To Promote Safe Surgery” and “Surgical Complication Prevention”