Surgical site Infection and classification.ppt

SSI

1. Surgical Site Infection

2. Definition of SSI
The CDC : =< 30 days of
surgery (or within a year in
the case of implants)
Mangram . Guideline for prevention of surgical
site infection, 1999. Infect Control Hosp Epidemiol 1999;

3. classificationincisional
surgical site infections
Superficial
Deep
Organ/space

4. superficial incisional
surgical site infections
< 30 days of procedure
involve only the skin or
subcutaneous tissue around
the incision.
Mangram . Guideline for prevention of surgical
site infection, 1999. Infect Control Hosp Epidemiol 1999

5. Deep incisional surgical
site infections
< 30 days of procedure (or one
year in the case of implants)
are related to the procedure
involve deep soft tissues, such
as the fascia and muscles.
Mangram . Guideline for prevention of surgical
site infection, 1999. Infect Control Hosp Epidemiol 1999

6. ASEPSIS WOUND
SCORING SYSTEM
[ Wilson AP, Lancet1986

9. Southampton wound
scoring system
[Bailey IS, BMJ1992; 304: 469-71

11. Risk Factors
Surgical factors
Patient-specific factors
local
systemic

12. Factors influencing SSIs
Patient Risk Factors
Local:
High bacterial
load
Wound
hematoma
Necrotic tissue
Foreign body
Obesity
Systemic:
Advanced age
Shock
Diabetes
Malnutrition
Alcoholism
Steroids
Chemotherapy
Immuno-
compromise

13. Factors influencing SSIs
Antibiotics
Prophylactic
Therapeutic

14. Factors influencing SSIs
Surgical Risk Factors
Type of procedure
Degree of contamination
Duration of operation
Urgency of operation
skin preparation
operating room environment
Antibiotic prophylaxis
EWMAJournal 2005; 5(2): 11-15.

15. Wound class Definition Example Infection
rate (%)
Clean Nontraumatic, elective
surgery. GI tract,
respiratory tract, GU tract
not entered
Mastectomy
Vascular
Hernias
2%
Clean-
contaminated
Respiratory, GI, GU tract
entered with minimal
contamination
Gastrectomy
Hysterectomy
< 10%
Contaminated Open, fresh, traumatic
wounds, uncontrolled
spillage, minor break in
sterile technique
Rupture appy
Emergent
bowel resect.
20%
Dirty Open, traumatic, dirty
wounds; traumatic
perforation of hollow
viscus, frank pus in the
field
Intestinal
fistula
resection
28-70% Berard F, Gandon J, Ann Surg1964

16. Reduce hemoglobin A1c levels
to <7% before operation
Evidence
Class II data
References
Anderson DJ, Kaye KS, Classen D, et
al. Strategies to prevent surgical site
infections in acute care hospitals.
Infect Control Hosp Epidemiol 2008;

17. Smoking cessation 30 d
before operation
Evidence
Class II data
References
Anderson DJ, Kaye KS, Classen D, et
al. Strategies to prevent surgical site
infections in acute care hospitals.
Infect Control Hosp Epidemiol 2008

18. Remove hair only if it will interfere with
the operation; hair removal by clipping
immediately before the operation or
with depilatories; no pre-or
perioperative shaving of surgical
Evidence
Class I data
References
Kjønniksen I. Preoperative hair removal–
a systematic literature review. AORN J
2002

19. Use an antiseptic surgical scrub
or alcohol-based hand antiseptic
for preoperative cleansing of the
operative team members’ hands
and forearms
Evidence
Class II data
References
Anderson DJ. Strategies to prevent
surgical site
infections in acute care hospitals.
Infect Control Hosp Epidemiol 2008;

20. Prepare the skin around the
operative site with an appropriate
antiseptic agent, including
preparations based on alcohol,
chlorhexidine, or iodine/iodophors
Evidence
Class II data
References
Anderson . Strategies to prevent
surgical site
infections in acute care hospitals.
Infect Control Hosp Epidemiol 2008;

21. Administer prophylactic antibiotics
for most clean-contaminated and
contaminated procedures, and
selected clean procedures use
antibiotics appropriate for the
potential pathogens
Evidence
Strong Class I data
References
Springer R. The Surgical care
improvement project-focusing on infection
control.Plast Surg Nurs 2007;

22. Administer prophylactic antibiotics within
1 h before incision (2 h for vancomycin
and fluoroquinolones)
Evidence
Strong Class II data
References
Springer R. The Surgical care
improvement project-focusing on
infection control.Plast Surg Nurs
2007

23. Use higher dosages of
prophylactic antibiotics
for morbidly obese patients
Evidence
Limited Class II data
References
Springer R. The Surgical care
improvement project-focusing on
infection control.Plast Surg Nurs
2007

24. Carefully handle tissue, eradicate dead
space, and adhere to standard principles
of asepsis
Evidence
Class III
References
Anderson DJ. Strategies to prevent
surgical site infections in acute care
hospitals. Infect Control Hosp
Epidemiol 2008;

25. Redose prophylactic antibiotics with
short half-lives intraoperatively if
operation is prolonged (for cefazolin if
operation is >3 h) or if there is
extensive blood loss
Evidence
Limited Class I, Class II data
References
Scher K. Studies on the duration of
antibiotic administration for surgical
prophylaxis Am Surg 1997

26. Maintain intraoperative
normothermia
Evidence
Class I; some contradictory Class II
data
References
Sessler DI, Akca O.
Nonpharmacological prevention of
surgical wound infections.
Clin Infect Dis 2002

27. Discontinue prophylactic
antibiotics within 24 h after the
procedure (48 h for cardiac surgery
&liver transplant procedures)
discontinue prophylactic
antibiotics after skin closure
Evidence
Class I;
meta-analyses support single dose
regimens for prophylaxis
References ASHP Therapeutic guidelines on antimicrobial
prophylaxis in surgery. Am J Health Syst Pharm 1999

28. Maintain serum glucose
levels <200 mg/dL on PO
Evidence
Class II data
References
Anderson DJ. Strategies to prevent
surgical site infections in acute care
hospitals. Infect Control Hosp
Epidemiol 2008

29. Monitor wound for the
development of SSI
postoperative days 1 and 2d
Evidence
Class III data
References
Anderson DJ. Strategies to prevent
surgical site infections in acute care
hospitals. Infect Control Hosp
Epidemiol 2008

30. •opening the wound I&D .
•For most patients who have had their
wounds opened and adequately
drained, antibiotic therapy is unnecessary.
Treatment of SSI
Stevens DL. Prguidelines for the diagnosis and management of skin and soft-tissue
infections. Clin Infect Dis 2005actice

31. o use antibioticsonly when there are
significant systemic signs of infection
(temperature higher than
38.5Cor heart rate greater than 100
beats/min)
erythema extends more than 5 cm
from the incision.
Stevens DL. Prguidelines for the diagnosis and management of skin and
soft-tissue infections. Clin Infect Dis 2005actice
Treatment of SSI