THE GOAL OF THIS CONTINUING EDUCATION PROǧ GRAM is to provide perioperative nurses, pharmacists and sur-


gical technologists with information about preventing surgical site infections. After studying the information presented here, you will be able to:


1 2 3


P


List three physiologic risk factors in patients associated with increased potential for SSIs


Discuss the rationale for administering prophylactic anti- biotics as close to the time of surgical incision as possible


Describe how perioperative caregivers can help prevent SSIs


By Nancymarie Phillips, PhD, RN, RNFA, CNOR(E); Connie C. Chettle, MS, MPH, RN; and Barbara Barzoloski-O’Connor, MSN, RN, CIC


atients are used to signing consent forms that list infection as a potential risk of surgery, but they probably don’t grasp the scope of the problem. An estimated 1 of 25 patients


has a hospital-acquired infection on any given day, according to the Centers for Disease Control and Prevention. A 2011 CDC report indicated that of 722,000 HAIs, there are about 157,500 associated surgical site infections (SSIs).1


An article in the New


England Journal of Medicine ranks both SSIs and pneumonia as No.1 in the distribution of HAIs in 2014, both approaching 40%. Te article found that 39.1% of the pneumonia cases were ventilator associated.1,2 Patients with an SSI have longer hospital stays (seven to 11 days)


and higher morbidity. Patients with an SSI have an increased risk of dying as a direct result of the SSI at a rate of 77%.3


contribute significantly to U.S. healthcare expenses, costing an estimated $3.5 billion to $10 billion each year.3


What is a surgical site infection? An SSI is an infection related to an operative procedure that occurs at or near the incision (incisional or organ/space) within 30 days — or within one year if an implant is left in place.3


SSIs


complicate the recovery of 2% to 5% of patients with extra-ab- dominal surgeries (e.g., thoracic and orthopedic surgeries) and of up to 20% of patients with intra-abdominal procedures (e.g., gynecologic and colon surgeries). SSIs account for nearly 40% of all healthcare-associated infections among surgical patients and are the second most commonly reported healthcare-associated infections, making up 22% of all such infections.2


Reduction of SSI Te Surgical Care Improvement Project is a set of performance measures developed by Te Centers for Medicare & Medicaid Ser- vices, Te Joint Commission, CDC, American College of Surgeons and American Hospital Association to serve as a framework to monitor progress and improve patient safety. Te high numbers of SSIs have raised concerns about patient


safety and led the national organizations to design the SCIP, focused on reducing patient surgical complications and reducing preventable surgical morbidity and mortality by 25% by 2010. (It has not been determined whether it has achieved its goals.). Te organizations developed performance measures as part of SCIP to reduce the morbidity and mortality associated with postop SSIs. As an added incentive for preventing SSIs, CMS has stopped


SSIs also


Deep SSI • Deep


incision primary is when one incision is used.


• Deep


incision secondary is when two or more


incisions are used


Organ/ Space SSI


Involves underlying anatomic structures manipulated during the surgery not including the skin, muscle or fascia


paying hospitals the extra costs of treating patients with some of the HAIs that reasonably could be prevented by following evidence-based guidelines. Medicare diagnosis-related group payments will also be affected by how well hospitals perform in SCIP measures. Private insurers will likely follow Medicare’s lead in withholding payments in the near future. Monetary penalties may be what are needed to ensure that every


hospital follows the SCIP initiatives for reducing SSIs. More than 10 years ago, the CDC issued guidelines for the prevention of SSIs. Tese were followed by guidelines from the Surgical Infection Prevention Project in 2002 and then by the SCIP performance measures in 2005. Over the years, the measures have changed slightly to incorporate not only infection-related elements, but


WHAT IS A SURGICAL SITE INFECTION?3 Tissue


Type of infection


6XSHUƬFLDO


,QFLVLRQDO SSI


Skin or subcutane- ous tissue. No deeper than adipose tissue. Muscle and fascia not involved


Deep soft tissues, such as fascia or muscle


Signs and symptoms


Purulent drainage


Organisms isolated IURP ưXLG WLVVXH aerobic organisms


2QH VLJQ RI LQưDP- mation, such as pain or tenderness, indu- ration or erythema


Purulent drainage from deep incision EXW ZLWKRXW RUJDQ space involvement


Deep inision dehis- cence, or surgeon deliberately opens incision because RI VLJQV RI LQưDP- mation. Aerobic or anaerobic microor- ganisms


,GHQWLƮFDWLRQ RI DQ abscess above the level of the fascia


Purulent drainage from a drain placed LQWR WKH RUJDQ VSDFH


Organisms isolat- ed from a culture RI ưXLG RU WLVVXH LQ WKH RUJDQ VSDFH below the level of the fascia. Usually anaerobic micro- organisms


,GHQWLƮFDWLRQ RI an abscess in the


RUJDQ VSDFH 2016 • Visit us at NURSE.com 29


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