surgical site infection.pptx

surgical site infection

1. Surgical site infection care bundle Mathivathani M Clinical instructor KGMU College of Nursing

2. SURGICAL SITE INFECTION The CDC defines - SSI as  an infection related to a surgical procedure that occurs near the surgical site within 30 days following surgery  (or up to 90 days following surgery where an implant is involved)

3. Classification

4. Conts… Event occurs within 30 days Purulent drainage from wound. Positive wound culture. Pain, redness, swelling. Diagnosis by surgeon. Event occurs within 30-90 days Purulent drainage from deep aspect of the wound Dehiscence Fever > 38 C Abscess on other evidence histopathology/Gross anatomy/ imaging study Superficial incisional SSI Deep incisional SSI Organ /Space SSI Event occurs within 30-90 days Involved deeper (cavity/organ) Purulent drainage from deep aspect of the wound Dehiscence Fever > 38 C Abscess on other evidence involvement of organ histopathology/Gross anatomy/ imaging study

5. What is care bundle? A 'care bundle' is  a collection of interventions/ Set of evidence based practice

6. Core Prevention Strategies- Pre-Operative Do NOT remove patient hair, or if absolutely necessary, remove with a clipper, do not shave 1 2 Do not use antibiotic prophylaxis routinely for uncomplicated clean surgeries without prosthetic implants. Administer surgical antibiotic prophylaxis in the 120 minutes preceding surgical incision (depending on the type of operation and the half- life of the antibiotic)

7. 3 Skin Prep: Use appropriate alcohol containing antiseptic agent (unless contraindicated) and technique for skin preparation Maintain normothermia in patient throughout the surgery. 4

8. Maintain normoglycaemia in patient throughout the surgery. Screen preoperative blood glucose levels and maintain tight glucose control POD#1 and POD#2 in patients undergoing select elective procedures Carry out mechanical bowel preparation always combined with administering preoperative oral antibiotics in adults patients undergoing elective colorectal surgery 5 6

9. Intra operative Measures Operating Room (OR) Traffic Keep OR doors closed during surgery except as needed for passage of equipment, personnel, and the patient 1 2 Use sterile Surgical attire Use sterile drapes and sterile instruments

10. Surgical Wound Dressing Protect primary closure incisions with sterile dressing for 24-48 hrs post-op Control blood glucose level during the immediate post-operative period (cardiac surgeries) Maintain post-op blood glucose level at <200mg/dL Post operative Measures 9 10

11. Advise the Patient bathes or showers prior to surgery with either plain or antimicrobial soap / Antiseptic agent Use 2% mupirocin decolonization in known nasal carriers of Staphylococcus aureus in cardiac and orthopedic surgery (consider for other surgeries) 1 2 Supplemental Prevention Strategies- Pre operative

12. Redose antibiotic at the 3 hr interval in procedures with duration >3hrs. Adjust antimicrobial prophylaxis dose for obese patients (body mass index >30) 3 Peri operative Use at least 80 % fraction of inspired oxygen intraoperatively and immediately postoperatively in select procedure. 4

13. Before initiating any antibiotic for suspected SSI, wound sample must be sent for culture to microbiology lab. 5 Post operative