Surgical_Site_Infections_Detailed_40_Slides_Dr_Gull_Bibi_Colored.pptx

Surgical site infection

1. Surgical Site Infections: Prevention and Treatment Dr. Gull Bibi Final Year Postgraduate Resident Gynae Department, Ghurki Teaching Hospital, Lahore Based on NICE Guideline NG125 (Updated August 2020)

2. Introduction Surgical Site Infection (SSI) is a type of healthcare-associated infection occurring after an invasive procedure. Accounts for up to 20% of all healthcare-associated infections. At least 5% of surgical patients develop an SSI. Most are preventable through effective pre-, intra-, and postoperative measures.

3. Impact of SSI Increased morbidity and prolonged hospital stays. Can range from minor discharge to life-threatening complications. Financial burden to healthcare providers. More common in high-risk patients due to advanced surgical eligibility.

4. Target Audience of Guidelines Healthcare professionals involved in surgical care. Commissioners and providers of surgical services. Patients, families, and carers involved in surgical decision-making.

5. Patient Information & Education Provide clear, consistent advice on SSI risks, prevention, and management. Educate on wound care after discharge. Recognising signs of SSI and when to seek help. Always inform patients if antibiotics were administered intraoperatively.

6. Preoperative Showering Advise shower or bath with soap the day before or day of surgery. Assist patients unable to bathe independently.

7. Nasal Decolonisation Consider mupirocin with chlorhexidine wash for high-risk S. aureus procedures. Decision should be locally determined based on patient risk factors. Maintain surveillance on antimicrobial resistance.

8. Hair Removal Avoid routine hair removal. If necessary, use electric clippers with single-use head on day of surgery. Avoid razors to reduce infection risk.

9. Theatre Wear Provide appropriate theatre wear for patients ensuring comfort and dignity. Staff must wear specific non-sterile theatre wear in all operative areas. Minimise staff movement in and out of theatre.

10. Mechanical Bowel Preparation Do not use routinely for SSI prevention.

11. Hand & Nail Preparation Operating team must remove jewellery, artificial nails, and nail polish.

12. Antibiotic Prophylaxis Indicated for clean surgery with prosthesis, clean-contaminated, contaminated surgeries. Avoid in clean non-prosthetic uncomplicated surgery. Follow local antibiotic formulary; give single IV dose at induction unless tourniquet used.

13. Hand Decontamination First case: wash with antiseptic surgical solution using brush/pick for nails. Subsequent cases: use alcoholic rub or antiseptic wash if soiled.

14. Incise Drapes Avoid non-iodophor-impregnated drapes. If required, use iodophor-impregnated unless allergic to iodine.

15. Gowns & Gloves Wear sterile gowns during operation. Consider double-gloving when high glove perforation risk.

16. Skin Preparation Preferred: alcohol-based chlorhexidine unless near mucous membrane. Alternatives: aqueous chlorhexidine, povidone-iodine preparations. Ensure drying before diathermy; avoid pooling.

17. Patient Homeostasis Maintain normothermia during surgery. Ensure adequate oxygenation and perfusion. Do not use insulin in non-diabetics solely to reduce SSI risk.

18. Wound Irrigation & Lavage Do not use routinely for SSI prevention.

19. Antiseptics & Antibiotics Before Closure Avoid routine application except in research trials. Consider gentamicin-collagen implants in cardiac surgery.

20. Closure Methods Consider triclosan-coated sutures, especially in paediatric surgery. Prefer sutures over staples in caesarean section.

21. Dressings Cover incisions with appropriate interactive dressing post-op.

22. Postoperative Dressing Changes Use aseptic non-touch technique for changing/removing dressings.

23. Postoperative Cleansing Sterile saline for wound cleaning up to 48 hours. Tap water if wound opened after 48 hours. Shower permitted after 48 hours.

24. Topical Antimicrobials Avoid in primary intention wounds. Avoid outdated agents like Eusol, mercuric solutions in secondary intention.

25. Secondary Intention Healing Use appropriate interactive dressings. Seek tissue viability nurse advice for complex wounds.

26. Antibiotic Treatment of SSI Treat suspected SSI with antibiotics targeting likely organisms. Consider local resistance patterns and culture results.

27. Debridement Avoid Eusol, dextranomer, or enzymatic agents for debridement.

28. Specialist Wound Care Adopt structured care approach including pre-op risk assessment. Educate healthcare workers, patients, and carers.

29. Research Recommendations - Nasal Decolonisation Effectiveness across all surgical populations. Impact on antimicrobial resistance.

30. Research Recommendations - Antiseptic Skin Prep Effectiveness of different chlorhexidine concentrations. Single vs. double application effectiveness.

31. Research Recommendations - Closure Methods Effectiveness of triclosan-coated sutures in various layers and patient groups. Impact of barbed sutures and methods in emergency surgery.

32. References NICE Guideline NG125 (2019, updated 2020). Surgical site infections: prevention and treatment. Available at: https://www.nice.org.uk/guidance/ng125