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Prevention & Management of


SURGICAL SITE INFECTION ( SSI )

F Siusanto Hadi, SpBKBD


INTRODUCTION
What is SSI ?
How does SSI occure ?
How does the Risk Increase ?
SSI rate <2%

SSI rate 4%-10%

SSI rate 20%

SSI rate 40%


What micro-organism ?
When suspect SSI ?
The 12 symptoms listed below:
Pus draining from wound
Increased redness around wound
Red streak from wound towards heart
Increased wound tenderness
Increased wound pain
Increased wound swelling
Heat at site of wound
Delayed healing
Unusual smell
Black dead tissue around wound
Enlarged lymph node
Fever
Symptoms

Bleeding
Pain
Swelling
Redness
Fever
Broken sutures
Open wound
SSI Classification
SSI Classification
SSI Classification
Factor affecting Incidence SSI

Surgical
•. •. •.
Patient Chr OT & ICU
SSI prevention bundle
SSI prevention bundle
Appropriate use of Ab
Appropriate Hair Removal
Appropriate Hair Removal
Post Op Glucose Control

140-180 mg/dl
Post Op Normothermia: Why ?
Post Op Normothermia
How to make Normothermia?

36-38 C
How to memorize ?

C: Clippers – remove hair


appropriately
A: Antibiotics - use prophylactic
antibiotics appropriately
T: Temperature – maintain
normothermia
S: Sugar – maintain glucose control
What You should Measure ?
MEASUREMENT
Quality Indicator Numerator Denominator
Appropriate antibiotic Number of patients who All patients for whom
choice received the appropriate prophylactic antibiotics
prophylactic antibiotic are indicated
Appropriate timing of Number of patients who All patients for whom
prophylactic antibiotics received the prophylactic antibiotics
prophylactic antibiotic are indicated
within 1hr prior to
incision (2hr:
Vancomycin or
Fluoroquinolones)
Appropriate Number of patients who All patients who
discontinuation of received prophylactic received prophylactic
antibiotics antibiotics and had them antibiotics
discontinued in 24 h
(48h cardiac)
MEASUREMENT
Quality Indicator Numerator Denominator
Appropriate hair Number of patients All surgical patients
removal who did not have hair
removed or who had
hair removed with
clippers
Normothermia Number of patients All surgical patients
with postoperative
temperature ≥36.0oC
Glucose control Number of cardiac Patients undergoing
surgery patients with cardiac surgery
glucose control at 6AM
POD1 and POD2
(operation = POD0)
SSI RATE
# Patients with SSI after selected operations X 100 Total #
of selected operations performed
Management of SSI
Management of SSI :
Recommendation 1
Management of SSI :
Recommendation 2
Management of SSI :
Recommendation 3
Management of SSI :
Recommendation 4
Management of SSI :
Recommendation 5
Management of SSI :
Recommendation 6
Management of SSI :
Recommendation 7
Acute SSI
Levine’s technique / z stroke
1. Bersihkan dgn NaCl 0,9%
steril
2. Pus yg keluar, jaringan
necrotic : jangan diambil
3. Gunakan cotton swab
steril, hingga ujungnya
sampai ke dasar, tekan
dasar luka
4. Gerakkan hingga
menyentuh dari ujung ke
ujung luka, secara zigzag,
dari ujung ke ujung luka
Management of SSI :
Recommendation 8
Management of SSI :
Recommendation 9
Management of SSI :
Recommendation 10
Management aspects :
Future
Minimally
invasive surgery
Prevent SSI
Summary
Summary (2)
Summary (3)
Summary (4)
• Postoperative phase
– Dressing changes (aseptic, non-touch technique)
– Postoperative wound cleansing
– Appropriate interactive dressings for wounds
– Antibiotic treatment of surgical site infections (SSIs)
– Referral for specialist wound care services
– Enhanced education of healthcare workers, patients, and
carers
?
Jawab dengan Cepat

1. Kertas HVS warnanya apa ?

2. Awan warnanya apa ?

3. Tissue warnanya apa ?

4. Sapi minumnya apa ?


1. Rambut anda warnanya apa ?

2. Alis warnanya apa ?

3. Aspal warnanya apa ?

4. Kelelawar tidurnya kapan ?


Thank you
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