Surgical Site Infection Prevention: Guidelines, Recommendations and Best Practice

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1 Surgical Site Infection Prevention: Guidelines, Recommendations and Best Practice Linda Goss BS, MSN, APN-BC, CIC, COHN-S Director, Infection Prevention and Control and Vascular Access Specialist Team University of Louisville Hospital Louisville, KY

2 SSI Infection Prevention Learning Objectives At the end of this presentation the learner will be able: Identify risk factors associated with surgical site infections Describe the process for implementing a SSI prevention team List SSI prevention methods

3 Impact of SSI Infections Estimated US Data Procedures Performed: estimated 14 million in 2002 (cdc.gov) Infections identified: ~300,000/year (second to UTI s) Mortality: 3% 75% of deaths of patients with SSI are attributable to the SSI Morbidity: long term disabilities

4 Impact of SSI Infections Estimated US Data Length of Stay:~ 7-10 additional days Costs: $ ,000 and amount to a total of nearly 10 billion Data is based on inpatient costs and don t include re-hospitalization, post discharge expenses and potential disabilities

5 Pathogenesis of SSI Infections Hospital Patient Without Infection Endogenous Sources of Pathogens Patient with SSI or SSI related death

6 Pathogenesis of SSI Infections Hospital Patient Without Infection Skin Endogenous Sources of Pathogens Patient with SSI or SSI related death

7 Pathogenesis of SSI Infections Hospital Patient Without Infection Skin Mucous Membranes Endogenous Sources of Pathogens Patient with SSI or SSI related death

8 Pathogenesis of SSI Infections Hospital Patient Without Infection Skin Endogenous Sources of Pathogens Mucous Membranes GI Tract Patient with SSI or SSI related death

9 Pathogenesis of SSI Infections Hospital Patient Without Infection Skin Endogenous Sources of Pathogens Seeding Mucous Membranes GI Tract Patient with SSI or SSI related death

10 Pathogenesis of SSI Infections Hospital Patient Without Infection Exogneous Sources of Pathogens Surgical Team OR Environment Equipment Patient with SSI or SSI related death

11 Pathogenesis of SSI Infections Hospital Patient Without Infection Exogneous Sources of Pathogens Soiled Clothing Poor Technique Surgical Team Poor Hand hygiene OR Environment Equipment Patient with SSI or SSI related death

12 Pathogenesis of SSI Infections Hospital Patient Without Infection Exogneous Sources of Pathogens Patient with SSI or SSI related death

13 Pathogens of SSI Infections Hospital Patient Without Infection Staphylococcus aureus Coagulase-negative staphylococcus Enterococcus spp Escherichia coli Pseudomonas aeruginosa Enterobacter spp Klebsiella pneumoniae Candida spp Klebsiella oxytoca Acinetobacter baumannii Patient with SSI or SSI related death

14 The Centers for Disease Control and Prevention National Healthcare Safety Network classification for surgical site infection (SSI). Reproduced from Horan et al

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19 Risk Factors Inappropriate choice of antibiotics for prophylaxis Improper timing of antibiotics Inadequate dose Inappropriate hair removal Ineffective skin preparation Improper intraoperative temperature

20 Risk Factors OR traffic Wound closure or dressing Lack of glucose control Colonized skin Inadequate oxygenation intraoperatively

21 Challenges Compliance with best practice Cohesive relationships Turnover in staff Facilitating process change from the top Inadequate or inefficient data Support/resources

22 Transitioning from Here

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24 To Here

25 Team Approach Anesthesiology Nursing Education Quality Data Support/IT Infection Control Surgery HIM Administration SPD EVS Products

26 Baseline Determine current rate of infection Establish standard process for collecting and analyzing data Identify key stakeholders Determine barriers Determine who needs vs who wants data Align policies/protocols

27 Strategize Research current initiatives Perform a gap analysis SWOT Review past successes Prioritize initiatives

28 Current Initiatives Surgical Care Improvement Project (SCIP) Developed with CMS in 2003 Partners with AHA, CDC, IHI, TJC Evidenced based and endorsed by NQF Goal of reducing morbidity and mortality Measures are components of measures collected by other initiatives including Core Measures, ASC/NSQIP

29 Current Initiatives Surgical Care Improvement Project (SCIP) Strategies in SCIP that are core are evidenced based Have been proven to be effective Proven to be easily implemented Include administering antibiotics 1 hour prior to incision

30 Current Initiatives Institute for Healthcare Improvement (IHI) Nationwide quality improvement project Recommends SCIP prevention measures Reproduced in 100,000 and 5 Million Lives Saved campaigns

31 Current Initiatives Centers for Medicare and Medicaid Services (CMS) Deficit Reduction Act of 2005 Medicare funded acute care inpatient prospective payment system (IPPS) Full payment if quality measures submitted SCIP measures part of IPPS

32 Guidelines Guideline for the Prevention of Surgical Site Infection, 1999 ICHE vol.20 No. 4 Guideline for Disinfection and Sterilization in Healthcare Facilities 2008 Rutala,W Weber, D and Healthcare Infection Control Practices Advisory Committee (HICPAC) Guide to the Elimination of Orthopedic Surgical Site Infections 2010, Association for Professionals in Infection Control and Epidemiology Strategies to Prevent Surgical Site Infections In Acute Care Hospitals 2008 Infection Control and Hospital Epidemiology WHO Guidelines for Safe Surgery: Safe Surgery Saves Lives 2009 World Health Organization

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35 Prevention Prevention is a collaborative process that demands focused and engaged effort Combining and enhancing current initiatives supports a solid foundation for change Knowledge sharing and dissemination promotes continued success

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