Академический Документы
Профессиональный Документы
Культура Документы
(HOSPITAL ACQUIRED
CONDITIONS)
AND SURGICAL SITE INFECTION
Jocliedian G L
Deny Budiman
Achmad Prihadianto
Hendrikus MB Bolly
What
What are
are Hospital
Hospital Acquired
Acquired Infections
Infections
(HAIs)
(HAIs)
Blood
Blood Stream
Stream Infections
Infections
Ventilator
Ventilator Associated
Associated Pneumonia
Pneumonia (VAP)
(VAP)
Surgical
Surgical Site
Site Infections
Infections (SSI)
(SSI)
Urinary
Urinary Catheter
Catheter Associated
Associated Infection
Infection
(CAUTI)
(CAUTI)
Multi-drug
Multi-drug Resistant
Resistant Organism
Organism (MRO)
(MRO)
Blood
Blood Stream
Stream Infections
Infections
(BSI)
(BSI)
Ventilator
Ventilator Associated
Associated
Pneumonia
Pneumonia (VAP)
(VAP)
Surgical
Surgical Site
Site Infections
Infections
(SSI)
(SSI)
Catheter
Catheter Associated
Associated Urinary
Urinary
Tract
Tract Infections
Infections (CAUTI)
(CAUTI)
Multidrug
Multidrug Resistant
Resistant Organism
Organism
(MRO)
(MRO)
SSI Definition
A surgical site infection is an infection that occurs
after surgery in the part of the body where the
surgery took place. Most patients who have
surgery do not develop an infection. However,
infections develop in about 1 to 3 out of every
100 patients who have surgery.
Some of the common symptoms of a surgical site
infection are:
Redness and pain around the area where you had
surgery
Drainage of cloudy fluid from your surgical wound
Fever
Types of SSI
Superficial Incisional SSI
Infection occurs within 30
days after the operation
and involves only skin or
subcutaneous tissue
of the incision
Skin
Superficial
incisional
SSI
Subcutaneou
s tissue
Superficial
incisional SSI
Deep
incisional SSI
Organ/Space SSI
Infection occurs within 30 days after
the operation if no implant is left in
place or within 1 year if implant is in
place and the infection appears to
be related to the operation and the
infection involves any part of the
anatomy, other than the incision,
which was opened or manipulated
during the operation
Superficial
incisional
SSI
Deep
incisional SSI
Organ/
space
Mangram AJ et al. Infect Control Hosp Epidemiol. 1999;20:250-278.
Organ/spac
e SSI
Duration of surgical
scrub
Maintain body temp
Skin antisepsis
Preoperative shaving
Duration of operation
Antimicrobial
prophylaxis
Operating room
ventilation
Inadequate sterilization
of instruments
Foreign material at
surgical site
Surgical drains
Surgical technique
Poor hemostasis
Failure to obliterate
dead space
Tissue trauma
Age
Diabetes
HbA1C and SSI
Glucose > 200 mg/dL
postoperative period
(<48 hours)
SSI Pathogens
Risk Stratification
Principles of Antibiotic
Prophylaxis
Preop administration, serum levels adequate
throughout procedure with a drug active
against expected microorganisms.
High Serum Levels
1. Preop timing
2. IV route
3. Highest dose
of drug
During
Procedure
1. Long half-life
2. Long procedure
redose
3. Large blood
lossredose
Duration
1. None after
wound closed
2. 24 hours
maximum
Skin Prep
Use appropriate antiseptic agent and technique for skin
preparation
Operating Room (OR) Traffic
Keep OR doors closed during surgery except as needed
for passage of equipment, personnel, and the patient
Colorectal surgery patients
Mechanically prepare the colon (Enemas, cathartic
agents)
Administer non-absorbable oral antimicrobial agents in
divided doses on the day before the operation
Prevention Strategies:
Supplemental
Conclusion
SSI is preventable
Prevention is the best
References
http://www.jointcommission.org/PerformanceMeasurement/
PerformanceMeasurement/SCIP+Core+Measure+Set.htm
http://www.cdc.gov/ncidod/dhqp/gl_surgicalsite.html
http://www.ihi.org/IHI/Topics/PatientSafety/SurgicalSiteInfectio
ns
/
Bode LGM, et al. Preventing SSI in nasal carriers of Staph
aureys. NEJM 2010;362:9-17.
Engelmann R et al. The Society for Thoracic Surgeons
Practice Guideline Services: Antibiotic Prophylaxis in Cardiac
Surgery, Part II: Antibiotic Choice. Ann Thor Surg
2007;83:1569-76
Fry DE. Surgical Site Infections and the Surgical Care
Improvement Project (SCIP): Evolution of National Quality
Measures. Surg Infect 2008;9(6):579-84