Reducing surgical site infection in a hospital in Singapore


Environment


 OT traffi c/attire  Post-operative, ie recannulation  High-dependency unit  Pre-operative, ie showers


Staff


 Skill-mix  nurse  Physiotherapy  Other patients  Aseptic technique  Cross-infection  Attire


Equipment


 Sequential compression device  Drainage systems (closed or open)


Page points


1. Unplanned hypothermia increases the likelihood of postoperative myocardial infarction, admission to intensive care units and mortality rates


Infection Sterilisation 


Surgical technique  Operating time  Drains 


 Selection  Expectations  Compliance  Confusion  Pressure ulcer  Nutritional status


Patients


Urinary catheter  Clipping 


Temp monitoring 


Glucose monitoring  Hair removal 


Prophylactic antibiotics  Procedure


Figure 2 – Diagram demonstrating the risk factors for SSI.


risk factor for SSI and it correlates with the occurrence of SSI[7, 8]


. Unplanned hypothermia also increases


the likelihood of postoperative myocardial infarction, admission to intensive care units and mortality rates. Warmed intravenous (IV) fluids, increased ambient temperature in the hospital’s operating room and the use of warming blankets during surgical procedures can also maintain normothermia in patients.


RESULTS With the bundle of interventions described above, the hospital’s overall SSI rate was


reduced year on year at the following rates: n


n n n n


3.1% in 2005 0.7% in 2006 0.4% in 2007 1.1% in 2008 1.2% in 2009.


When compared with data from the US’s National Nosocomial Infections


 Blood loss  Drainage systems  Storage of equipment  Post-operative haematoma  Dressings (time and type)  Epidural insertion


2. Warmed intravenous (IV) fl uids, increased ambient temperature in theatre and the use of blankets during surgical procedures can also maintain normothermia


References


8. Kurz A, Sessler D, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical- wound infection and shorten hospitalization. New Eng J Med 1996; 334(19): 1209.


80 70 60 50 40 30 20 10 0


82% 58% 92% 97% 98% 99% 100%


100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%


9. NNIS. System Report: Data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32(8): 470–85.


10. Edmiston CE, Seabrook GR, Goheen MP, Krepel CJ, Johnson CP, Lewis BD, Brown KR, Towne JB. Bacterial adherence to surgical sutures: can antibacterial-coated sutures reduce the risk of microbial contamination? J Am Coll Surg 2006; 203(4): 481–9.


Figure 3 – Pareto chart demonstrating the most important risk factors for intervention planning.


www.woundsinternational.com


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Practice development


Prophylactic antibiotics


Glucose monitoring Hair removal


Temperature monitoring


Operating time


Aseptic technique OT traffi c


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