Surgical site infections (SSIs) are currently the most common cause of healthcare-associated infections, and cost our healthcare system approximately $10 billion annually. Infection following surgery also doubles a patient’s likelihood for hospitalization and death.1Fortunately, the incidence of surgical site infections has been gradually decreasing in recent years, but there is still plenty of room still for further improvement. In today’s blog post an overview of some fundamental components included in an infection prevention protocol will be presented.

 

Pre-op Preparations

Monitor patient nutrition

Malnourished patients are at an increased risk for infection and other surgical complications.2Screening questions regarding reduced dietary intake and weight loss have shown an association with increased infection rates.3Other indicators of nutritional status, such as albumin levels and blood sugar levels, may also help to provide additional information regarding patient risk for developing an SSI.2,4

 

Screen for colonization and deliver pre-op antibiotics

All patients should be screened in the weeks prior to surgery to determine if they are carriers of certain colonies of bacteria, such as MRSA. A patient who is positive for MRSA has a 30-60% greater risk of developing an SSI without the proper prophylaxis prior to surgery. Pre-op antibiotics should be given to all patients within 60 minutes of incision time at the appropriate dose. Patient’s who are MRSA-positive should have their pre-surgical prophylaxis changed to vancomycin.1

 

Skin preparation

Proper removal of contaminants on the skin at the surgical site including residual oils and hair in the surgical site lowers the risk of the surgical site becoming contaminated. Chlorheidine Gluconate (CHG) liquid soap or CHG-containing wipes help to reduce resident microorganisms to sub-pathogenic levels without irritating the patient’s skin.1

 

In the Operation Room

Traffic control

Limiting foot traffic in the operating room to only the essential members of the surgical team, and keeping door openings to a minimum helps limit the bacteria count.1,2All required equipment should be brought in prior to or at the same time as the time the patient is rolled into to operating room. It may be useful to post a sign outside the door and inform non-members of the surgical staff to not enter the operating room unless necessary.

 

Ensure attire, surfaces, and tools/instruments follow the set standards for practice

Guidelines for Perioperative Practices regarding the condition standards of the operating room can be found from the Association for perioperative Registered Nurses (AORN) at https://www.aorn.org/guidelines/clinical-resources/aorn-standards. Compliance with the American College of Surgeons (ACS) guidelines for appropriate operating room attire is also an integral component to limit the number of SSIs.5

                      

Post-Op

Protect the incisions

Surgical wounds are most susceptible to infection immediately following surgery until approximately 48-72 hours have passed. Adhesive wound-closing products should be applied while the patient is in the operating room to form a strong barrier against microorganisms.1Health care providers need to clean their hands with soap and water or an alcohol-based hand rub prior to examining the surgical incision.6

 

Educate patients

Patients should be educated on how to properly take care for their wound before leaving the hospital, including when the wound dressing can be removed. In addition, signs of wound infection should also be discussed so that if infection does develop the patient can inform the doctor in a timely manner and prevent further complications.6Early detection of an infection has a significant influence on patient prognosis.

 

Summary

Coordinated, ongoing efforts from all members included in the care of a patient before, during, and after surgery are required in order to defend against the threat of surgical infection. If you have a client who suffered from a SSI, it is crucial to determine if negligence by one or more members of the healthcare team contributed to their post-surgical complications or if it is was unfortunately unavoidable due to a myriad of pre-existing conditions with increased risk of infections.

 

References

  1. Spencer, M. 6 Ways to Stamp Out Superbugs. Outpatient Surgery Magazine. 2018; 12. Available at: http://www.outpatientsurgery.net/surgical-facility-administration/infection-control/6-ways-to-stamp-out-superbugs–12-18. Accessed January 13, 2019.
  2. Cook, D. Infection-free Joint Replacements. Outpatient Surgery Magazine. 2018;8. Available at: http://magazine.outpatientsurgery.net/i/1012667-special-outpatient-surgery-edition-orthopedics-august-2018/47.Accessed January 13, 2019.
  3. Skeie E, Koch AM, Harthug S, et al. A positive association between nutritional risk and the incidence of surgical site infections: A hospital-based register study. PLoS One. 2018;13(5). doi:10.1371/journal.pone.0197344

4.Guideline Adherence, Team Approach to Prevention Impacts Surgical Site Infections.Infectioncontroltoday.com. https://www.infectioncontroltoday.com/ssi/guideline-adherence-team-approach-prevention-impacts-surgical-site-infections. Published April 3, 2017. Accessed January 13, 2019.

  1. Statement on Operating Room Attire. Bulletin of the American College of Surgeons. Available at: https://www.facs.org/about-acs/statements/87-surgical-attire/. Published October 2016. Accessed January 13, 2019.
  2. CDC. FAQs about “Surgical Site Infections”. Cdc.gov. https://www.cdc.gov/hai/pdfs/ssi/ssi_largertext.pdf. Accessed January 13, 2019.