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SURGICAL SITE INFECTIONS an update working protocol

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Society for Microbiology and Infection care
Society for Microbiology and Infection care

This document discusses surgical site infections (SSIs), including causes, symptoms, and strategies for prevention. It notes that while advances have been made in infection control, SSIs remain common, with the CDC estimating that 1 in 3 surgeries result in infection. SSIs can range from superficial wound infections to serious infections involving deep tissues or implants. Proper hand hygiene and aseptic techniques during surgery are emphasized as important prevention strategies. New technologies like antibacterial sutures may also help reduce SSIs when combined with proper antibiotic use and infection protocols. Coordination between surgeons, nurses, and other professionals is important for identifying and treating SSIs.

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SURGICAL SITE INFECTIONS an update working protocol Dr.T.V.Rao MD 22-02-2016 Dr.T.V.Rao MD 1
Beginning to know Microbes cause Infections • Louis Pasteur had just disproved the common belief that microbes spontaneously came into existence on substrates like meat broth. By proving instead that dust and air carried the germs, he ushered in the golden age of microbiology and anchored the growing “Germ Theory” of illness - that germs caused and spread disease. In 1861, 26% of all Civil War amputations resulted in death because of our inability to control germs. At that point, amputation was actually the best possible treatment for most battle wounds. 22-02-2016 Dr.T.V.Rao MD 2
In spite of many advances we are still with many Surgical Site Infections • It’s disappointing, then, that the CDC currently predicts 1 of every 3 surgeries today in the U.S. will result in an infection. While fewer of those will be fatal than the Civil War surgeries, pain and suffering are inevitable (along with other complications). 22-02-2016 Dr.T.V.Rao MD 3
Surgical Site Infection • A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. Surgical site infections can sometimes be superficial infections involving the skin only. 22-02-2016 Dr.T.V.Rao MD 4
Every Surgical Procedure has an Impact • Infections that occur in the wound created by an invasive surgical procedure are generally referred to as surgical site infections (SSIs). SSIs are one of the most important causes of healthcare-associated infections (HCAIs). 22-02-2016 Dr.T.V.Rao MD 5
We are Underestimating Surgical Site Infections • SSIs accounted for 14% of these infections and nearly 5% of patients who had undergone a surgical procedure were found to have developed an SSI. However, prevalence studies tend to underestimate SSI because many of these infections occur after the patient has been discharged from hospital 22-02-2016 Dr.T.V.Rao MD 6
Identifying a Surgical site Infection a priority • SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related, at least in part, to SSI. However, it is important to recognise that SSIs can range from a relatively trivial wound discharge with no other complications to a life- threatening condition 22-02-2016 Dr.T.V.Rao MD 7
Out Come of Surgical Site Infections • Other clinical outcomes of SSIs include poor scars that are cosmetically unacceptable, such as those that are spreading, hypertrophic or keloid, persistent pain and itching, restriction of movement, particularly when over joints, and a significant impact on emotional wellbeing 22-02-2016 Dr.T.V.Rao MD 8
Surgical Site Infection •Other surgical site infections are more serious and can involve tissues under the skin, organs, or implanted material. 22-02-2016 Dr.T.V.Rao MD 9
Symptoms include •Redness and pain around the area where you had surgery •Drainage of cloudy fluid from your surgical wound •Fever 22-02-2016 Dr.T.V.Rao MD 10
After surgery • If you do not see your providers clean their hands, please ask them to do so. • Family and friends who visit you should not touch the surgical wound or dressings. • Family and friends should clean their hands with soap and water or an alcohol-based hand rub before and after visiting you. If you do not see them clean their hands, ask them to clean their hands. 22-02-2016 Dr.T.V.Rao MD 11
Caring the Wound and Hand Washing a Priority •Make sure you understand how to care for your wound before you leave the hospital. •Always clean your hands before and after caring for your wound. 22-02-2016 Dr.T.V.Rao MD 12
Contacting Surgeon or Nurse is a Priority •If you have any symptoms of an infection, such as redness and pain at the surgery site, drainage, or fever, call your doctor immediately22-02-2016 Dr.T.V.Rao MD 13
What are some of the things that hospitals are doing to prevent SSIs • To prevent SSIs, doctors, nurses, and other healthcare providers should follow CDC infection prevention guidelines including: • Clean their hands and arms up to their elbows with an antiseptic agent just before the surgery. • Clean their hands with soap and water or an alcohol- based hand rub before and after caring for each patient. 22-02-2016 Dr.T.V.Rao MD 14
Trends to Control the Surgical Site Infections • If indicated, remove some of your hair immediately before your surgery using electric clippers if the hair is in the same area where the procedure will occur. • Wear special hair covers, masks, gowns, and gloves during surgery to keep the surgery area clean. • When indicated, give you antibiotics before your surgery starts. In most cases, you should get antibiotics within 60 minutes before the surgery starts and the antibiotics should be stopped within 24 hours after surgery. • Clean the skin at the site of your surgery with a special soap that kills germs. 22-02-2016 Dr.T.V.Rao MD 15
Out Come of Surgical site Infections • SSI can double the length of time a patient stays in hospital and thereby increase the costs of health care. Additional costs attributable to SSI have been reported depending on the type of surgery and the severity of the infection. The main additional costs are related to re-operation, extra nursing care and interventions, and drug treatment costs. The indirect costs, due to loss of productivity, patient dissatisfaction and litigation, and reduced quality of life, have been studied less extensively 22-02-2016 Dr.T.V.Rao MD 16
Who should monitor surgical site Infections in developing countries • Surgeons • Microbiologist • Theatre nurse • Surveillance coordinator • Infection control specialist • Medical Superintendent • Representative of the Hospital Management for timely funding 22-02-2016 Dr.T.V.Rao MD 17
Who should be responsible for taking decisions on Surgical site Infections • The appropriate treatment of established SSIs requires careful monitoring and communication between the multidisciplinary postoperative team (surgeons, intensivists, microbiologists, and the primary care team. If patients are to be returned home early then any SSI needs to be recognised and treated appropriately 22-02-2016 Dr.T.V.Rao MD 18
Decision Making in Surgical Site Infections • Release of pus, debridement and parenteral antibiotics, if indicated, usually requires a return to secondary care. Extensive wound breakdown may need specialist wound management to reduce bacterial burden in the open wound. Wound bed preparation may be required to encourage healing by secondary intention or facilitate secondary suture. 22-02-2016 Dr.T.V.Rao MD 19
Bring in Better Coordination with many Professionals • During the development of the guideline, we need expert advice from an anaesthetist and additional clinical representation from a surgeon and a theatre nurse. 22-02-2016 Dr.T.V.Rao MD 20
Better care of the Environment is a priority • Studies show that the opening and closing of doors during surgery allow for the entry of bacteria-carrying particles, which pose the risk of infection. While a closed-door policy would be unfeasible for the dynamic environment of today’s operating room, it is undoubtable that decreasing traffic into and out of the operating room during surgery would go a long way toward reducing the risk of infection 22-02-2016 Dr.T.V.Rao MD 21
Other effective measures in Surgical site Infections Prophylaxis and management of antibiotic-resistant bacteria Management of the operating theatre environment and environmental factors Anaesthetic factors relating to SSI. 22-02-2016 Dr.T.V.Rao MD 22
The science of Infection is changing every minute Literature search strategy • Initial scoping searches were executed to identify relevant guidelines (local, national and international) produced by other development groups. The reference lists in these guidelines were checked against subsequent searches to identify missing evidence. 22-02-2016 Dr.T.V.Rao MD 23
Today We are Lucky to prevent Infections • One and a half centuries later, we have hand hygiene, antibiotics, disinfectants, sterile fields and sterile instruments, heck - we are performing brain surgery with lasers attached to robot arms! 22-02-2016 Dr.T.V.Rao MD 24
Other New Advances to Reduce Surgical Site Infections • Antibacterial sutures, which are sutures coated with antibiotics, were developed to help the wound healing by reducing the risk of surgical site infections. Triclosan-coated sutures may be one of the most effective antimicrobial agents developed and we are expected to greatly contribute to decreasing SSIs 22-02-2016 Dr.T.V.Rao MD 25
New Advances to Reduce Surgical Site Infections • If combined with refined and aseptic surgery techniques and the proper use of prophylactic antibiotics. This might help to decrease the length of hospital stay for patients undergoing gastric cancer surgery. 22-02-2016 Dr.T.V.Rao MD 26
Reassure Patients with Surgical Site Infections 22-02-2016 Dr.T.V.Rao MD 27
Many Peer Reviewed Studies Indicate that Hand Washing still a Great priority 22-02-2016 Dr.T.V.Rao MD 28
22-02-2016 Dr.T.V.Rao MD 29
Attention of Viewers • I am thankful to many in the world who made me to achieve my desired goals faster than I thought, having > 3-5 million health professionals share and utilize my knowledge for the benefit of mankind, Today I wish to be freelancer to the world to create interest in Medical, Clinical and Diagnostic Microbiology with more emphasis on Infectious diseases and Hospital associated Infection wish to be your partner in educating many millions who know well the importance of Infectious diseases • You can visit many web sites of mine • www.medmicrobes.com • www.slidehsare.com • www.authourstream.com • www,scribd.com • Be a friend on Facebook with tummalapalli venkateswararao access • Rao’s Microbiology • Rao’s Infection care • Microbiology connected Travancore Medical College • For any assistance on INFECTION REALTED ISSUES CONTACT ME AT doctortvrao@gmail.com •Mob +91 720411315422-02-2016 Dr.T.V.Rao MD 30
•Program Created by Dr.T.V.Rao MD for Benefit of Medical and Paramedical Professionals in the Developing World Created from World Wide Resources •Email •doctortvrao@gmail.com 22-02-2016 Dr.T.V.Rao MD 31

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SURGICAL SITE INFECTIONS an update working protocol

  • 1. SURGICAL SITE INFECTIONS an update working protocol Dr.T.V.Rao MD 22-02-2016 Dr.T.V.Rao MD 1
  • 2. Beginning to know Microbes cause Infections • Louis Pasteur had just disproved the common belief that microbes spontaneously came into existence on substrates like meat broth. By proving instead that dust and air carried the germs, he ushered in the golden age of microbiology and anchored the growing “Germ Theory” of illness - that germs caused and spread disease. In 1861, 26% of all Civil War amputations resulted in death because of our inability to control germs. At that point, amputation was actually the best possible treatment for most battle wounds. 22-02-2016 Dr.T.V.Rao MD 2
  • 3. In spite of many advances we are still with many Surgical Site Infections • It’s disappointing, then, that the CDC currently predicts 1 of every 3 surgeries today in the U.S. will result in an infection. While fewer of those will be fatal than the Civil War surgeries, pain and suffering are inevitable (along with other complications). 22-02-2016 Dr.T.V.Rao MD 3
  • 4. Surgical Site Infection • A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. Surgical site infections can sometimes be superficial infections involving the skin only. 22-02-2016 Dr.T.V.Rao MD 4
  • 5. Every Surgical Procedure has an Impact • Infections that occur in the wound created by an invasive surgical procedure are generally referred to as surgical site infections (SSIs). SSIs are one of the most important causes of healthcare-associated infections (HCAIs). 22-02-2016 Dr.T.V.Rao MD 5
  • 6. We are Underestimating Surgical Site Infections • SSIs accounted for 14% of these infections and nearly 5% of patients who had undergone a surgical procedure were found to have developed an SSI. However, prevalence studies tend to underestimate SSI because many of these infections occur after the patient has been discharged from hospital 22-02-2016 Dr.T.V.Rao MD 6
  • 7. Identifying a Surgical site Infection a priority • SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related, at least in part, to SSI. However, it is important to recognise that SSIs can range from a relatively trivial wound discharge with no other complications to a life- threatening condition 22-02-2016 Dr.T.V.Rao MD 7
  • 8. Out Come of Surgical Site Infections • Other clinical outcomes of SSIs include poor scars that are cosmetically unacceptable, such as those that are spreading, hypertrophic or keloid, persistent pain and itching, restriction of movement, particularly when over joints, and a significant impact on emotional wellbeing 22-02-2016 Dr.T.V.Rao MD 8
  • 9. Surgical Site Infection •Other surgical site infections are more serious and can involve tissues under the skin, organs, or implanted material. 22-02-2016 Dr.T.V.Rao MD 9
  • 10. Symptoms include •Redness and pain around the area where you had surgery •Drainage of cloudy fluid from your surgical wound •Fever 22-02-2016 Dr.T.V.Rao MD 10
  • 11. After surgery • If you do not see your providers clean their hands, please ask them to do so. • Family and friends who visit you should not touch the surgical wound or dressings. • Family and friends should clean their hands with soap and water or an alcohol-based hand rub before and after visiting you. If you do not see them clean their hands, ask them to clean their hands. 22-02-2016 Dr.T.V.Rao MD 11
  • 12. Caring the Wound and Hand Washing a Priority •Make sure you understand how to care for your wound before you leave the hospital. •Always clean your hands before and after caring for your wound. 22-02-2016 Dr.T.V.Rao MD 12
  • 13. Contacting Surgeon or Nurse is a Priority •If you have any symptoms of an infection, such as redness and pain at the surgery site, drainage, or fever, call your doctor immediately22-02-2016 Dr.T.V.Rao MD 13
  • 14. What are some of the things that hospitals are doing to prevent SSIs • To prevent SSIs, doctors, nurses, and other healthcare providers should follow CDC infection prevention guidelines including: • Clean their hands and arms up to their elbows with an antiseptic agent just before the surgery. • Clean their hands with soap and water or an alcohol- based hand rub before and after caring for each patient. 22-02-2016 Dr.T.V.Rao MD 14
  • 15. Trends to Control the Surgical Site Infections • If indicated, remove some of your hair immediately before your surgery using electric clippers if the hair is in the same area where the procedure will occur. • Wear special hair covers, masks, gowns, and gloves during surgery to keep the surgery area clean. • When indicated, give you antibiotics before your surgery starts. In most cases, you should get antibiotics within 60 minutes before the surgery starts and the antibiotics should be stopped within 24 hours after surgery. • Clean the skin at the site of your surgery with a special soap that kills germs. 22-02-2016 Dr.T.V.Rao MD 15
  • 16. Out Come of Surgical site Infections • SSI can double the length of time a patient stays in hospital and thereby increase the costs of health care. Additional costs attributable to SSI have been reported depending on the type of surgery and the severity of the infection. The main additional costs are related to re-operation, extra nursing care and interventions, and drug treatment costs. The indirect costs, due to loss of productivity, patient dissatisfaction and litigation, and reduced quality of life, have been studied less extensively 22-02-2016 Dr.T.V.Rao MD 16
  • 17. Who should monitor surgical site Infections in developing countries • Surgeons • Microbiologist • Theatre nurse • Surveillance coordinator • Infection control specialist • Medical Superintendent • Representative of the Hospital Management for timely funding 22-02-2016 Dr.T.V.Rao MD 17
  • 18. Who should be responsible for taking decisions on Surgical site Infections • The appropriate treatment of established SSIs requires careful monitoring and communication between the multidisciplinary postoperative team (surgeons, intensivists, microbiologists, and the primary care team. If patients are to be returned home early then any SSI needs to be recognised and treated appropriately 22-02-2016 Dr.T.V.Rao MD 18
  • 19. Decision Making in Surgical Site Infections • Release of pus, debridement and parenteral antibiotics, if indicated, usually requires a return to secondary care. Extensive wound breakdown may need specialist wound management to reduce bacterial burden in the open wound. Wound bed preparation may be required to encourage healing by secondary intention or facilitate secondary suture. 22-02-2016 Dr.T.V.Rao MD 19
  • 20. Bring in Better Coordination with many Professionals • During the development of the guideline, we need expert advice from an anaesthetist and additional clinical representation from a surgeon and a theatre nurse. 22-02-2016 Dr.T.V.Rao MD 20
  • 21. Better care of the Environment is a priority • Studies show that the opening and closing of doors during surgery allow for the entry of bacteria-carrying particles, which pose the risk of infection. While a closed-door policy would be unfeasible for the dynamic environment of today’s operating room, it is undoubtable that decreasing traffic into and out of the operating room during surgery would go a long way toward reducing the risk of infection 22-02-2016 Dr.T.V.Rao MD 21
  • 22. Other effective measures in Surgical site Infections Prophylaxis and management of antibiotic-resistant bacteria Management of the operating theatre environment and environmental factors Anaesthetic factors relating to SSI. 22-02-2016 Dr.T.V.Rao MD 22
  • 23. The science of Infection is changing every minute Literature search strategy • Initial scoping searches were executed to identify relevant guidelines (local, national and international) produced by other development groups. The reference lists in these guidelines were checked against subsequent searches to identify missing evidence. 22-02-2016 Dr.T.V.Rao MD 23
  • 24. Today We are Lucky to prevent Infections • One and a half centuries later, we have hand hygiene, antibiotics, disinfectants, sterile fields and sterile instruments, heck - we are performing brain surgery with lasers attached to robot arms! 22-02-2016 Dr.T.V.Rao MD 24
  • 25. Other New Advances to Reduce Surgical Site Infections • Antibacterial sutures, which are sutures coated with antibiotics, were developed to help the wound healing by reducing the risk of surgical site infections. Triclosan-coated sutures may be one of the most effective antimicrobial agents developed and we are expected to greatly contribute to decreasing SSIs 22-02-2016 Dr.T.V.Rao MD 25
  • 26. New Advances to Reduce Surgical Site Infections • If combined with refined and aseptic surgery techniques and the proper use of prophylactic antibiotics. This might help to decrease the length of hospital stay for patients undergoing gastric cancer surgery. 22-02-2016 Dr.T.V.Rao MD 26
  • 27. Reassure Patients with Surgical Site Infections 22-02-2016 Dr.T.V.Rao MD 27
  • 28. Many Peer Reviewed Studies Indicate that Hand Washing still a Great priority 22-02-2016 Dr.T.V.Rao MD 28
  • 30. Attention of Viewers • I am thankful to many in the world who made me to achieve my desired goals faster than I thought, having > 3-5 million health professionals share and utilize my knowledge for the benefit of mankind, Today I wish to be freelancer to the world to create interest in Medical, Clinical and Diagnostic Microbiology with more emphasis on Infectious diseases and Hospital associated Infection wish to be your partner in educating many millions who know well the importance of Infectious diseases • You can visit many web sites of mine • www.medmicrobes.com • www.slidehsare.com • www.authourstream.com • www,scribd.com • Be a friend on Facebook with tummalapalli venkateswararao access • Rao’s Microbiology • Rao’s Infection care • Microbiology connected Travancore Medical College • For any assistance on INFECTION REALTED ISSUES CONTACT ME AT [email protected] •Mob +91 720411315422-02-2016 Dr.T.V.Rao MD 30
  • 31. •Program Created by Dr.T.V.Rao MD for Benefit of Medical and Paramedical Professionals in the Developing World Created from World Wide Resources •Email •[email protected] 22-02-2016 Dr.T.V.Rao MD 31