This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
1
3M Infection Prevention Division
SURGICAL SITE INFECTIONCATS
ROAZALINA HASANUDDIN
Manager, Clinical
RN, BSc (Hons), Post Basic Peri-Operative
Infection Prevention Division
3M Malaysia
Every Day Practices + 3M Solutions =Positive Patient Outcomes
2
3M Infection Prevention Division
OBJECTIVES
SSI Overview
Understand the Best Practices in Prevention of SSI
3
3M Infection Prevention Division
WHAT IS SURGICAL SITE INFECTION (SSI)?
SSI is the infection that occurs after
24 hours of surgery
4
3M Infection Prevention Division
SURGICAL SITE INFECTION
SSI usually occurs between _________ surgery.
SKIN
SUBCUTANEOUSTISSUE
DEEP SOFT TISSUE(MUSCLE)
ORGAN
Deep Incisional SSI
Organ /Space SSI
Superficial Incisional SSI
SSI CITERIA
24 hours to 30 days (non Implant).
24 hours to a Year for Implant Surgery
5
3M Infection Prevention Division
Respiratory16%
Surgical Site15%
Blood Stream13%
Urinary Tract32%
Other24%
SSI % vs other HAIs %
6
3M Infection Prevention Division
INFECTIONS
• Infections cause patients’ condition to worsen • Infections increase a patient’s risk of death
• Infections result in prolonged hospital stays
• Longer stays and more serious problems that must be treated result in higher costs
7
3M Infection Prevention DivisionFacts about Surgical Site Infections:
SSI account for 14 % to 16% of all nosocomial infections among hospitalized
patients
Estimated added cost per SSI: Average cost of an infection: $3,152
7.3 additional days in hospital
Number of deaths: ~10,000 due to SSI
Surgical site infections: Increase patient’s length of stay Increase need for powerful antibiotics Decrease positive outcome of surgery
Additional cost must be absorbed by the hospital
*CDC Guideline for the Prevention of SSI, 1999
8
3M Infection Prevention Division
CDC Guidelines for Prevention of Surgical Site Infection (1999)Symptoms: “Irritative Fever”
Purulent Drainage
Overwhelming Sepsis
DeathThus to reduce the risk of SSI, a systematic and realistic approach must be applied with the awareness that this risk is influenced by characteristics of the patient, operation, personnel, and hospital.
9
3M Infection Prevention Division
http://www.cdc.gov/hicpac/pdf/guidelines/SSI_1999.pdf GUIDELINE FOR PREVENTION OF SURGICAL SITE INFECTION, 1999
10
3M Infection Prevention Division
IHI
Use “CATS” to prevent SSI
How do we start to prevent SSIHow do we start to prevent SSI
11
3M Infection Prevention Division
SURGICAL SITE INFECTION PREVENTION SURGICAL SITE INFECTION PREVENTION
Describe the Best Practices to Prevent SSIs
http://www.cdc.gov/hicpac/pdf/guidelines/SSI_1999.pdf GUIDELINE FOR PREVENTION OF SURGICAL SITE INFECTION, 1999
A: Use Antibiotics Appropriately
C: Hair Removal
T: Maintain Normal Body temperature
S: Maintain Normal Blood Glucose
12
3M Infection Prevention Division
Hair follicles contain bacteria—released through friction, micro abrasions, cuts created by shaving with razors
Recommendations include: No hair removal at all Clipping(AORN 2011) has remove recommendation of depilatory use.
Inappropriate Razors Depilatory use
Describe Clinical Care Protocols and Best Practices to Prevent SSIs
Hair Removal
13
3M Infection Prevention Division
Do not remove hair unless it will interfere with surgical procedureIf removal necessary only use clippers Maintain the skin integrity Remove hair as close to the time of surgery as possiblePerform procedure outside of OT
Interventions for Hair Removal
Jepson et al SSI Rate
14
3M Infection Prevention Division
Hair Removal Methods:
No Hair Removal
Razor
Depilatory/Surgi-Cream
Clipper
15
3M Infection Prevention Division
Hair Removal
16
3M Infection Prevention Division
CLIPPER vs. RAZOR CLIPPER vs. RAZOR
Clipper Razor No micro-abrasions Causes micro-abrasions
17
3M Infection Prevention Division
CLIPPER vs. RAZOR CLIPPER vs. RAZOR
Clipper RazorLow chance of infection High chance of infection
Clinical Study
At time of discharge
Hair Clipping: 1.8 %.
Razor shaving: 6.4 %
At 30 days follow-up.
Hair Clipping: 3.2%
Razor shaving: 10% Alexander et al.
Hair removal methods using a razor compared to an electric clipper. The study showed that for hair removal performed the morning of surgery.
18
3M Infection Prevention Division
THE “FACTS”
We know what AORN 2010 says about hair removal…
Interpretive Statement 4:
“If hair is to be removed, it should be done in a mannerthat preserves skin integrity.”
Rationale:
“Hair removal by shaving can disrupt skin integrity…”
Discussion:
“An electric or battery powered clipper with a disposable orreusable head that can be disinfected between patients is
acceptable…”
19
3M Infection Prevention Division
Antibiotics administered within specific time framesGive initial dose of the IV antibiotic to provide a bactericidal level of drug in the
serum and tissues when incision is made (within 30 minutes prior to the incision)Provides concentration of the drug in serum and tissues that is at a bactericidal
level when the incision is made
Use Antibiotics Appropriately-Preoperative Antibiotic Prophylaxis
Describe Clinical Care Protocols and Best Practices to Prevent SSIs
20
3M Infection Prevention Division
Antibiotics present in the tissue at the time of the incision and for a specified period of time after surgery support existing host defenses in killing microorganisms present in the wound
For colon surgery, oral non-absorbable antibiotics may ALSO be used to reduce the counts of bowel microorganisms
Doses may be in the upper range for obese patients, and repeat doses of antibiotics may be necessary for long operations
Discontinue antibiotics within 24 hours after surgery except for cardiothoracic procedures in adult patients (as per ordered by doctors)
Use Antibiotics Appropriately-Preoperative Antibiotic Prophylaxis
21
3M Infection Prevention Division
Normothermia: the body’s ideal thermal state
Core temperature:3
37.0°C (98.6°F)
Temperature gradient: 2-4°C between the core and periphery
Core:37°C
Periphery:2-4°C cooler
3.Sessler DI. Current concepts: Mild Perioperative Hypothermia. New Engl J Med. 1997; 336(24):1730-1737.
Recruits more skin surface area to warm (at relatively low temperatures)
No risk of warming pressure points
27
3M Infection Prevention Division
Adverse effects of unintended hypothermia
There are many documented adverse effects of unintended hypothermia2 including:
Surgical site infection Morbid myocardial outcomes Blood loss and tranfusion requirement Prolonged and altered drug effect Prolonged recovery Shivering and patient discomfort
General or regional anesthesia
2. Sessler DI, Kurz A. Mild Perioperative Hypothermia. Anesthesiology News. October 2008: 17-28.
28
3M Infection Prevention Division
Surgical Wound Infections
Hypothermic colorectal surgical patients with mild hypothermia have:7
77
7. Kurz A, Sessler DI, et al. Perioperative Normothermia to Reduce the Incidence of Surgical-Wound Infection and Shorten Hospitalization. New Engl J Med. 1996;334:1209-1215.
Describe Clinical Care Protocols and Best Practices to Prevent SSIs
Increased risk for SSIs because of impaired host defenses from the disease Diabetes mellitus has long been considered a risk factor for SSI, studies
inconclusive. Postoperative medical complications more common in patients with diabetes
mellitus
SSI Host Factor: Diabetes Mellitus
30
3M Infection Prevention Division
Blood Sugar Concentration Level: Normal blood sugar ranges
For the majority of healthy individuals, normal blood sugar levels are as follows:
The normal blood glucose level in humans is about 4 mmol/L (72 mg/dL)The body, when operating normally, restores the blood sugar level to a
range of about 4.4 to 6.1 mmol/L (82 to 110 mg/dL) Shortly after eating the blood glucose level may rise temporarily up to 7.8
mmol/L (140 mg/dL)
31
3M Infection Prevention Division
Poor glycemic control is an independent risk factor for SSIs in a variety of surgical procedures.
Many patients may have had undiagnosed diabetes mellitusVigorous efforts to ensure patients with diabetes are well controlled and
glucose levels are carefully managed prior to, during, and following the surgical procedure
High-risk patients should be screened to stabilize and to control blood-glucose levels prior to the surgery.
Staff should set goals with the patient and family, such as lowering hemoglobin A1c levels to less than 7% before the surgical procedure
Interventions for Diabetes Mellitus
Describe Clinical Care Protocols and Best Practices to Prevent SSIs
32
3M Infection Prevention Division
Develop a single protocol for use on all surgical patients.Use a glucose control protocol, implementing a sliding scale or insulin
drip as appropriate.Check preoperative glucose levels on a regular basis on all patients to
identify hyperglycemia. Time the risk assessment to provide time for adequate treatment.
Designate a person responsible and accountable to monitor blood glucose and control.
www.IHI.org
Institute for Healthcare Improvement (IHI) Recommendations for Management of Glucose and A1c Levels in Coronary Artery Bypass Graft Patients
33
3M Infection Prevention Division
IHI
C A T S
Remember CATS remember SSI Preventions..
34
3M Infection Prevention Division
OR & CSSD Characteristics/Environment
Other Best Practices to Prevent SSIs
35
3M Infection Prevention Division
OR: Hand Hygiene
CDC: Hand Hygiene in Health-Care Settings Surgical hand antisepsis using either an antimicrobial scrub or an alcohol-based hand rub with persistent activity is recommended before donning sterile gloves when performing surgical procedures
Other Prevention of SSI
36
3M Infection Prevention Division
Surgical Hand Preparation
Optimum antiseptic Broad-spectrum activity Fast acting Persistent
Use agents that have been found to have greatest residual activity
For first scrub of the day - clean under nails It is not clear that such cleaning is necessary for subsequent
scrubsCDC GUIDELINE FOR PREVENTION OF SURGICAL SITE INFECTION, 1999
37
3M Infection Prevention DivisionStandardizes Procedure for Hand Hygiene
Hand wash:• Application technique, length of exposure to product, correct
concentration of product• Use of soap and water for at least 15 seconds
Hand rub:• Application technique, length of exposure to product, correct
concentration of product• Use of alcohol-based antiseptic hand rub when soil is not present on
hands• At least 15 seconds
Surgical hand scrub: • Application technique, length of exposure to product, correct
concentration of product• Use of either an antimicrobial surgical scrub agent or an alcohol-based
antiseptic surgical hand scrub
38
3M Infection Prevention Division
SURGICAL HAND RUB Formulations
(CDC)
Studies have demonstrated that formulations containing 60%–95% alcohol alone or 50%–95% when combined with limited amounts of a quaternary ammonium compound, hexachlorophene, or chlorhexidine gluconate (CHG), lower bacterial counts on the skin immediately post scrub more effectively than do other agents. .(Table 4)
39
3M Infection Prevention Division
OR: Surgical Solution (Skin Prep)
It is important to choose the proper and correct solution which its reduce the potential of skin microbes to contaminate the surgical wound.
Every surgical solutions should provides rapid bacteria kill and persistent antimicrobial activity.
Other Prevention of SSI
40
3M Infection Prevention Division
Selection of Skin Prep Agent
Desirable qualities Nonirritating chemical Broad spectrum activity Ability to act fast Persistent effect Difficult to wash away or inactivate by blood/saline
41
3M Infection Prevention Division
Antimicrobial Agents Key Terms
Persistent Activity Single application Ability to lower bacterial
count Maintain low count over
specified period of time
Cumulative Activity Repeated use Lower overall resident
bacterial count Count continues to
decrease over time
42
3M Infection Prevention Division
Selecting Antiseptic Products
• “When indicated, the surgical site and surrounding area should be prepared with an antiseptic agent”.
AORN Recommended Practice
• “Use an appropriate antiseptic agent for skin preparation”.Category IB
Patient Preoperative Skin Preparation
43
3M Infection Prevention Division
OR: Use of Surgical Barrier (Drapes)
Sterile Surgical Drapers protect the patient form infection by preventing microorganisms form making their way into the skin opening created during surgery.
If the drape gapes or moves, contamination can be introduced into the sterile field and an infection can arise because everything under the sterile surgical drape is a source of contamination.
Other Prevention of SSI
44
3M Infection Prevention Division
ISOLATIONISOLATION
6 PRINCIPLES OF DRAPING
STERILE FIELDSTERILE FIELD FLUID CONTROLFLUID CONTROL
Drapes used beforesurgery to wall off dirty areas or equipment.
These can be sterile or non-sterile drapes.
Any sterile drapeapplied to a surface in a sterile manner creates a sterile field.
Fluid collectionpouches collect bloodand body fluids.An absorbent drape that does not allow fluid strike -through also controls fluids byabsorbing spills andsplatters.
Sterile drapes usedduring the drapingprocess to create abarrier layer to blood and body fluids.
Incise drapes provide a sterile surface up to the wound edge.
Drapes that isolates and non-sterile equipment from the surgical siteand protects expensiveequipment.
6 PRINCIPLES OF DRAPING
46
3M Infection Prevention Division
SURGICAL DRAPES AND GOWNS
47
3M Infection Prevention Division
Surgical Drapes are designed to establish and maintain a sterile field. It is very important to select a surgical drape that provides reliable performance and
protection.
A drape that allows fluid transfer, and thus bacteria transfer, compromises the sterile field, which increases the risk of surgical site infection. That’s why creating a true barrier with a drape that’s
impervious to fluid strikethrough is so important.
NOT SUITABLENOT SUITABLE BEST PRACTICE BEST PRACTICE
48
3M Infection Prevention Division
CSSD Characteristics
Proper Instrument management in CSSD which include the proper Sterilization Monitoring Process
Other Prevention of SSI
49
3M Infection Prevention Division
Questions?
50
3M Infection Prevention Division
SURGICAL SITE INFECTION (SSI)
SSI usually occurs between _____________after Operation.