© megaflopp - Fotolia/Adobe Stock.
t
PERIOPERATIVE PRACTICE
Global guidelines on the prevention of SSI
Kate Woodhead RGN DMS provides an insight into the World Health Organization’s latest guidance on preventing surgical site infection.
Surgical site infections (SSIs) are continuing to cause patients substantial harm and are probably the most preventable of all healthcare-associated infections. Their presence interrupts and affects the health and lives of millions of people around the world every year. The exact number of people affected is unreliably counted in many countries but it is estimated that in low and middle income countries 11% of all those who undergo surgery are infected during the process. In Africa, up to 20% of the women who have a C-section on the continent, contract a wound infection – and it is probably the most commonly undertaken surgical procedure in Africa. Surgical site infections are, as regular readers of this journal will know, not just applicable in African countries, but in every country. We all need to review the recommendations; all 29 of them and incorporate them into our practice and national standards. The World Health Organization has recently launched the very first Global Guidelines for the prevention of surgical site infection1
, applicable in high, middle and low income countries to reduce SSIs. The WHO guidelines are valid in all countries and are suitable for local adaptation. They review all the most up to date evidence that is available, taking account of the strength of the available
scientific evidence, the cost and resource implications as well as patient values and preferences. The guidelines are designed to address the ever increasing burden of healthcare-associated infections on both patients and healthcare systems globally.
Resistance to new practice?
The global guidelines are said to be complementary to the elements of practice in the safe surgery saves lives checklist2
which
relate to infection control practices. One of the aspects of the introduction of the checklist in 2009, which is still being implemented in many countries and has been totally ignored by others, is that the guidelines fundamentally affect many practices which have been in place for years. It takes multidisciplinary education and training to ensure that the new practice is owned and believed in by everyone in the team. There will be many hospitals and surgical teams that do not respect the WHO checklist or practise it well on every single occasion and will find it equally difficult to change practice to reduce surgical site infections. The NICE Guidance has been a strongly evidence based set of recommendations, in place in the UK since 2008 and these are not universally practised.3 Leaper et al, writing in 2014,4
recognised
that even in the presence of strongly evidenced based guidelines, surgical site infection rates do not seem to be falling and that compliance with care bundles and guidance is poor. They cite that even with regular national surveillance data, which is believed to underestimate the prevalence of surgical site infection, reduction strategies and compliance with existing recommendations, is poor. It has been suggested that leadership and teamwork are especially required to manifest significant change in operating theatre practice.5,6
Risk factors for SSI
The risk factors for SSI are linked to patient characteristics, which include age related factors, diabetes, obesity and other co- morbidities; as well as surgical procedure factors which include contamination class, duration of surgery, surgical skill, normothermia, and the perioperative environment. The definition usually also mentions the possible routes of contamination (which relate to a number of the specific recommendations in the guidelines.) The routes suggest that much of the contamination occurs during the surgery, and are from the patient’s skin, from the surgical team, by the airborne route or from instruments used for the procedure.
FEBRUARY 2017
WWW.CLINICALSERVICESJOURNAL.COM I
15
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64
