also measures for beta blocker use and venous thromboembolism prevention. Yet despite evidence showing the effectiveness of the guidelines, many providers inconsistently comply.4
nents to the surgical site.3,5 Tis module
will provide healthcare professionals of various disciplines with the latest information about SCIP performance measures to reduce SSIs, including: • The prevention of infection through proper selection, tim- ing and administration of antimicrobial prophylaxis. Doses are adjusted according to body weight. Obese patients require larger doses for increased periods of time.3
• Proper hair removal with clippers or depilatory outside the OR3,5
• Maintenance of the patient’s body temperature between 36 C and 38 C (96.8 F and 100.4 F) within one hour of leaving the OR
By following these recommendations, an estimated 40% to 60% of SSIs can be prevented.3
Predicting the risk for SSI SSIs occur despite the best surgical techniques, the thoroughness of skin disinfection and the OR staff’s prevention strategies. At the time of incision, every surgical site becomes contaminated with bacteria inward from the skin or outward from the internal organ being operated on if disease-causing microorganisms are present. Most contamination is due to the patient’s endogenous flora present at the surgical site on the skin, on mucosal mem- branes or in the hollow digestive viscera. Other contamination can come from exogenous sources, such as the OR staff and environment, including the air ventilation system and surgical instruments.5
result in infection. Usually, innate host defenses can eliminate the contaminating organisms.5 When SSIs do develop, among the most important contributing
factors are the amount of bacteria inoculated into the wound, virulence of the bacteria and local blood flow — the delivery of oxygen, inflammatory cells, cytokines and nutritional compo-
Also important are the appropriate
administration of antibiotics and the adequacy of host immune defenses — innate or acquired. Patient-related risk factors also influence the development of
SSIs, including advanced age, obesity, diabetes, malnutrition, poor tissue perfusion, the use of steroids or other immunosuppressant drugs, a preoperative stay in a hospital (more than four days), colonization with Staphylococcus aureus or remote infection at the time of surgery.5
Additional factors include radiation therapy to
the surgical site, blood transfusion (causes reduced macrophage activity) and previous history of SSI.3,5 Diabetic patients with poor blood glucose control are at signifi-
cant risk for postoperative infection. Patients with a preoperative blood glucose level of 200 mg/dL or more have a greater risk of SSI. Hyperglycemia results in impaired host defenses by impairing polymorphonuclear leukocyte functions, including adherence, chemotaxis, phagocytosis and bactericidal activity. In a study of cardiothoracic patients, hyperglycemia was associated with a 102% increase in the risk for wound infection.3
the risk of infection increases fourfold if the patient becomes hyperglycemic at any time on the first postop day.3 A1C levels should be maintained below 7%.3
It appears that Patients’ blood Hospitals should have
a standardized glucose management protocol for all patients undergoing surgery. Procedural techniques can influence the risk for infection,
But for most patients, bacteria in a wound does not
such as using the electrocautery on the skin. Residual “dead space” in the wound after closure can lead to infection by cre- ating favorable living conditions for bacteria to multiply. Some surgeons use a wound edge protector drape or an adhesive incise sheet over the exposed skin before the incision is made as a preventive measure. Te incise sheets can be plain clear plastic or impregnated with iodophor. A common practice is to irrigate the surgical site with sterile saline or antibiotic solution before closing the skin.5 Environmental considerations include adequate surface cleaning with EPA-approved disinfectants and minimizing
FOUR CLASSES OF SURGICAL PROCEDURES were determined: clean, clean-contami- nated, contaminated and dirty or infected — each with a distinctive infection risk rate:5
Class 1: Clean procedures: DQ XQLQIHFWHG SULPDU\ VXUJLFDO LQFLVLRQ ZLWKRXW LQưDPPDWLRQ UHVSLUDWRU\ *, ELOLDU\ RU JHQLWRXULQDU\ WUDFWV QRW HQWHUHG
WR LQIHFWLRQ UDWH ZLWKRXW SURSK\ODFWLF DQWLELRWLFV &ORVHG E\ SUL-
mary intention and may be drained with closed-system drainage. May be a nonpenetrating blunt trauma injury opened for exploration in the OR. No break in sterile technique.
Class 2: Clean-contaminated procedures: VXUJLFDO LQFLVLRQV LQ ZKLFK UHVSLUDWRU\ *, ELOLDU\ DQG JHQLWRXULQDU\ tract are entered under controlled conditions with minimal spillage and no encounter with infected urine RU ELOH
WR LQIHFWLRQ UDWH ZLWKRXW SURSK\ODFWLF DQWLELRWLFV 1R EUHDN LQ VWHULOH WHFKQLTXH
Class 3: Contaminated procedures: open, fresh, accidental wounds (of less than four hours duration) and surger- LHV ZLWK PDMRU EUHDNV LQ VWHULOH WHFKQLTXH H J RSHQ FDUGLDF PDVVDJH RU JURVV VSLOODJH IURP WKH *, WUDFW DOVR LQFOXGHV LQFLVLRQV LQ ZKLFK DFXWH QRQSXUXOHQW LQưDPPDWLRQ LV HQFRXQWHUHG rate without prophylactic antibiotics.
WR LQIHFWLRQ
Class 4: Dirty/infected procedures: SXUXOHQW LQưDPPDWLRQ SUHVHQW ,QFOXGHV ROG WUDXPDWLF ZRXQGV RI PRUH than four hours duration) with retained dead tissues and those that involve existing clinical LQIHFWLRQ RU SHUIRUDWHG YLVFHUD DERXW infection rate without prophylactic antibiotics.
30 Visit us at
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