Process audit for SSI CME on Infection Prevention & Control Breach Candy Hospital Trust
Introduction SSIs are the most common healthcare-associated infection, accounting for 31% of all HAIs among hospitalized patient Associated with a mortality rate of 3% 75% of SSI-associated deaths are directly attributable to the SSI Surgical Site Infection (SSI) Event. Procedure-associated Module SSI, January 2015
CDC Classification of SSI (within 30 days of operation, within one year if implant in place) Incisional Superficial o Deep o Involve only skin and subcutaneous tissue Involve deep soft tissue Organ space Involve any part of anatomy other than incision open or manipulated skin Subcutaneous tissue Deep soft tissue (fascia & muscle) Organ / space Superficial incision SSI Deep incision SSI Organ / space SSI Surgical Site Infection (SSI) Event. Procedure-associated Module SSI, January 2015.
Source of pathogens 1. Endogenous flora patient s skin mucous membranes hollow viscera Hematogenous seeding of the operative site from a distant focus of infection David E. Reichman, et al. Reducing Surgical Site Infections: A Review Rev Obstet Gynecol. 2009 Alicia J. Mangram, et al. GUIDELINE FOR PREVENTION OF SURGICAL SITE INFECTION, 1999. ICHE
Source of pathogens 2. Exogenous sources Surgical personnel Instruments and materials the operating room environment David E. Reichman, et al. Reducing Surgical Site Infections: A Review Rev Obstet Gynecol. 2009 Alicia J. Mangram, et al. GUIDELINE FOR PREVENTION OF SURGICAL SITE INFECTION, 1999. ICHE
Risk factors Patient characteristics Operation characteristics
Patient related risk factors 1. Remote site infections or colonisation 2. Length of preoperative stay 3. Diabetes control 4. Preoperative hair removal 5. Preoperative bath with antiseptic agent 6. Age 7. Nutritional status 8. Smoking 9. Obesity Pola Brenner, et al. Prevention of Surgical Site Infections, IFIC Basic Concepts of Infection Control 2011 Deverick J. Anderson, et al. Strategies to Prevent Surgical Site Infections in Acute Care Hospitals, ICHE October 2008
Intraoperative factors Preparation of surgical site Antimicrobial prophylaxis Aseptic practices by every member of surgical team Surgical attires and drapes Duration of surgery Surgical technique/experience Placement of foreign bodies( implants, sutures, drains, etc.) Pola Brenner, et al. Prevention of Surgical Site Infections, IFIC Basic Concepts of Infection Control 2011 Deverick J. Anderson, et al. Strategies to Prevent Surgical Site Infections in Acute Care Hospitals, ICHE October 2008
Intraoperative 1. Ventilation Positive pressure Air changes Personnel traffic Laminar flow 2. Cleaning and disinfection of environmental surfaces 3. Sterilization of equipment 4. Microbiological sampling Pola Brenner, et al. Prevention of Surgical Site Infections, IFIC Basic Concepts of Infection Control 2011 Deverick J. Anderson, et al. Strategies to Prevent Surgical Site Infections in Acute Care Hospitals, ICHE October 2008
Post operative 1. Post operative incision care 2. Education of patient & relatives on wound care Pola Brenner, et al. Prevention of Surgical Site Infections, IFIC Basic Concepts of Infection Control 2011 Deverick J. Anderson, et al. Strategies to Prevent Surgical Site Infections in Acute Care Hospitals, ICHE October 2008
SSI Risk Stratification Categories of variables proven to be reliable predictors of SSI risk Those that estimate the intrinsic degree of microbial contamination of the surgical site Those that measure the duration of an operation NNIS risk index Either contaminated or dirty/infected wound classification Length of operation >T hours, where T is the approximate 75th percentile of the duration of the specific operation being performed those that serve as markers for host susceptibility American Society of Anesthesiologists (ASA) Physical Status Classification of >2 Deverick J. Anderson, et al. Strategies to Prevent Surgical Site Infections in Acute Care Hospitals, ICHE October 2008 Pola Brenner, et al. Prevention of Surgical Site Infections, IFIC Basic Concepts of Infection Control 2011
Practices audited Remote site infection /colonisation Preoperative bath with antiseptic agent Adequate glycemia control Method and timing of hair removal Length of preoperative stay Skin preparation Antimicrobial prophylaxsis Surgical scrub technique Duration of surgery Skills/experience of surgeon Placement of foreign bodies such as implants, drains OR ventilation Cleaning and disinfection of surfaces Sterilisation of equipments
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