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    Factors To Surgical Site Infections

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    AleXxHo
    Surgical site infections are the most common form of nosocomial infection, affecting 300,000-500,000 patients annually in the US. Proper hand washing and using chlorhexidine for skin preparation and scrubbing are the most effective ways to reduce SSIs. Other contributing factors include limiting surgical time, covering equipment, preventing hypothermia, and limiting breaches in sterile technique. Patient risk factors such as diabetes or obesity have less impact than modifiable perioperative factors.

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    Factors To Surgical Site Infections

    Uploaded by

    AleXxHo
    31 views22 pages
    Surgical site infections are the most common form of nosocomial infection, affecting 300,000-500,000 patients annually in the US. Proper hand washing and using chlorhexidine for skin preparation and scrubbing are the most effective ways to reduce SSIs. Other contributing factors include limiting surgical time, covering equipment, preventing hypothermia, and limiting breaches in sterile technique. Patient risk factors such as diabetes or obesity have less impact than modifiable perioperative factors.

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    Surgical site infections in orthopaedics and how to avoid them

    Original Title

    Factors to Surgical Site Infections

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    Surgical site infections are the most common form of nosocomial infection, affecting 300,000-500,000 patients annually in the US. Proper hand washing and using chlorhexidine for skin preparation and scrubbing are the most effective ways to reduce SSIs. Other contributing factors include limiting surgical time, covering equipment, preventing hypothermia, and limiting breaches in sterile technique. Patient risk factors such as diabetes or obesity have less impact than modifiable perioperative factors.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    31 views22 pages

    Factors To Surgical Site Infections

    Uploaded by

    AleXxHo
    Surgical site infections are the most common form of nosocomial infection, affecting 300,000-500,000 patients annually in the US. Proper hand washing and using chlorhexidine for skin preparation and scrubbing are the most effective ways to reduce SSIs. Other contributing factors include limiting surgical time, covering equipment, preventing hypothermia, and limiting breaches in sterile technique. Patient risk factors such as diabetes or obesity have less impact than modifiable perioperative factors.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 22

    Factors to Surgical Site

    Infections
    HO, ALEXANDER JR.
    Harrop, J. S., Styliaras, J. C., Ooi, Y. C., Radcliff, K. E., Vaccaro, A. R., & Wu, C. (2012).
    Contributing Factors to Surgical Site Infections
    Journal of the American Academy of Orthopaedic Surgeons
    Surgical Site Infection
    Most common form of nosocomial infection
    300,000 – 500,000 cases annually in the US
    Responsible for appox 77% of all deaths in patients with nosocomial infection
    Sequelae of SSIs
    Revision surgery
    Delayed wound healing
    Increased use of antibiotics
    Increased length of hospital stay
    Hand washing
    Single most critical measure in reducing the risk of transmitting microorganisms
    Removes transient microorganisms and reduces resident microorganisms
    Selecting an Antiseptic Agent
    Alcohol was associated with the most rapid and greatest reduction in colony-forming units
    (CFUs)

    Chlorhexidine also demonstrated a reasonable reduction in CFUs; more importantly, however,


    this agent had more persistent activity, which can be attributed to increased binding to the skin

    Iodine was associated with the smallest reduction in CFUs and had little to no residual effect.
    Bacteria returned to baseline levels after 6 hours
    Scrub Duration
    CDC recommends – 2 to 6 minutes
    Surgical Site Skin Preparation
    Approximately two thirds of all SSIs are confined to the surgical incision site
    Endemic skin bacterial flora, such as gram-positive bacteria, account for most such infections
    Surgical Site Skin Preparation
    Randomized controlled trial of 234 patients

    5-minute scrub using povidone-iodine followed by a paint with povidone-iodine or with


    povidone-iodine paint alone.

    Rate of SSI was 10% in both groups

    CFUs were found on the skin in patients prepared with scrub and paint than in the patients
    prepared with paint alone.
    Selecting an Antiseptic Agent
    2007 – Digison et al – Chlorhexidine in combination with alcohol proved to be the most effective
    agent overall

    Rate of infection
    2009 – Swenson et al –
    Povidone Iodine 4.8%
    Chlorhexidine 8.2%

    2010 – Darouiche et al - Rate of infection


    Povidone Iodine 16.1%
    Chlorhexidine 9.5%
    Neurotoxicity of Chlorhexidine
    Chlorhexidine
    ◦ Not used extensively in cranial and spine surgery
    ◦ Neuronal damage proportional to the concentration
    ◦ Damaged nerves do regenerate
    Toxicity of Povidone Iodine
    Significant corneal edema at >1.5%
    Adhesive incision drapes
    Cochrane review of 3,082 patients

    Rate of infection
    With 13.4%
    Without 11.2%
    Preoperative Hair Shaving
    Facilitated skin marking
    Clarified orientation for the surgeon
    Expedited closure
    Seemingly had the potential for reducing the risk of infection
    Preoperative Hair Shaving
    Microtrauma from hair shaving has been felt to increase bacterial colonization
    Shaving adds to the length of surgery

    10-year prospective study of 62,939 surgical wounds


    Rate of infection
    With Shaving 1.4%
    (Electric Shaver)
    With Shaving 2.5%
    (Manual Shaver)
    Without Shaving 0.9%
    Operating Room Behavior
    1,032 observations

    Standard antiseptic protocol Vs Extensive antiseptic protocol

    No significant difference was found between the two protocols

    Rate of infection
    Standard 14%
    Extensive 15%
    Operating Room Behavior
    The four factors that had a particular impact on SSIs
    ◦ exchange of surgical team members
    ◦ movement in the operating room
    ◦ operating room noise
    ◦ presence of visitors
    Operating Room Behavior
    Largest role in increasing the risk of SSIs
    ◦ body mass index >30kg/m2
    ◦ surgeon experience
    ◦ duration of surgery
    Surgical Duration
    Surgical duration above the 75th percentile has been shown to be an independent risk factor for
    SSI

    >2 hours is an independent risk factor for SSI in both orthopaedic and general surgical patients

    2010, Procter et al - prospective systematic study involving 299,359 operations in 173 hospitals
    ◦ Risk of infection increased 2.5% and that the odds ratio increased by 0.32 for every 30 minutes of
    surgery
    Surgical Duration
    Exposure to airborne pathogens, considerable surgical trauma, and increased opportunities for
    violations in sterile technique
    Patient Related Risk Factors
    Preexisting diabetes mellitus

    Obesity

    History of prior SSI

    Methicillin-resistant Staphylococcus aureus (MRSA) colonization


    Summary
    Hand washing
    Chlorhexidine scrub with duration of atleast 2 minutes
    Chlorhexidine used for operative skin preparation
    Adhesive incision drapes and preoperative shaving – limited effect in reducing SSIs
    Shorter surgical time
    Covering equipment whenever possible
    Preventing intraoperative hypothermia
    Limiting repetitive minor breaches in sterile technique
    Patient-related risk factors do not appear to play as significant a role as perioperative factors

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