Ssi ;problems&prevention

03/28/11 08:13 AM Surgical Site Infections: Problems and Prevention. Dr. P.S.Reddy, MD De partment of Microbiology & Infectious Diseases NARAYANA MEDICAL COLLEGE.

Objectives ,[object Object],[object Object],[object Object],[object Object],03/28/11 08:13 AM

Why SSI as a Topic? ,[object Object],[object Object],[object Object],[object Object],03/28/11 08:13 AM

SSI definition ,[object Object],03/28/11 08:13 AM

Criteria for Defining SSI ,[object Object],[object Object],[object Object],[object Object],03/28/11 08:13 AM

Do not report the following conditions as SSI: ,[object Object],[object Object],[object Object],[object Object],03/28/11 08:13 AM

Public Health Importance of SSI. ,[object Object],[object Object],03/28/11 08:13 AM ( SP Lilani, et al. IJMM 2005 23: 4: 249-252)

03/28/11 08:13 AM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(Kirkland KB et al, Infect Control Hosp Epidemiol. 1999 Nov;20(11):725-30).

03/28/11 08:13 AM Cross Section of Abdominal Wall Depicting CDC Classification on SSI(1992).

Source of SSI Pathogens ,[object Object],[object Object],[object Object],03/28/11 08:13 AM

03/28/11 08:13 AM Microbiology of SSI 1986-1989 1990-1996 Staphylococcus aureus 17% Coagulase neg. staphylococci 12% Escherichia coli 10% Enterococcus spp. 8% Pseudomonas aeruginosa 8% Staphylococcus aureus 20% Coagulase neg. staphylococci 14% Escherichia coli 8% Enterococcus spp. 12% Pseudomonas aeruginosa 8%

Microbiology of SSIs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],03/28/11 08:13 AM

Pathogenesis of SSI ,[object Object],03/28/11 08:13 AM

SSI Risk Factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],03/28/11 08:13 AM

Are they Preventable?. If so How?. 03/28/11 08:13 AM

Antimicrobial Prophylaxis (AP) in SSI. ,[object Object],[object Object],[object Object],[object Object],[object Object],03/28/11 08:13 AM Prosepective study of 2,847 cases Classen, 1992 (NEJM 326:281-286)

Impact of Prolonged Surgical AP ,[object Object],[object Object],[object Object],03/28/11 08:13 AM (Prosepective study of 2,641 cases Classen, 1992 (NEJM 326:281-286)

Enhanced Perioperative Glucose Control in Diabetic Patients ,[object Object],[object Object],03/28/11 08:13 AM Furnary AP; Ann Thorac Surg, 2000 • Glucose levels < 200 mg%

Supplemental Perioperative O 2 ,[object Object],[object Object],[object Object],03/28/11 08:13 AM (Greif, R, et al , NEJM, 2000)

03/28/11 08:13 AM Most studies shows antiseptic showering decreases colony counts. No Shower Shower Cruse, 1973 2.3% 1.3% Ayliffe, 1983 4.9% 5.4% Rooter, 1988 2.4% 2.6% Pre-operative Antiseptic Showers/Baths

03/28/11 08:13 AM Seropian, 1971 Method of hair removal Razor : 5.6% Depilatory : 0.6% No hair removal : 0.6% Timing of hair removal Shaving immediately before : 3.1% Shaving  24 hours before : 7.1% Shaving >24 hours before : 20 % Pre-operative Shaving / Hair Removal

03/28/11 08:13 AM Multiple studies show Clipping immediately before operation associated with lower SSI risk than shaving or clipping the night before operation Pre-operative Shaving/Hair Removal

Surgical Attire ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],03/28/11 08:13 AM

Surgical technique ,[object Object],[object Object],[object Object],[object Object],[object Object],03/28/11 08:13 AM

Surgery Room Ventilation ,[object Object],[object Object],[object Object],03/28/11 08:13 AM (American Institute of Architects, 1996)

Role of HEPA filters in Preventing SSI ,[object Object],[object Object],[object Object],[object Object],03/28/11 08:13 AM

Post operative care ,[object Object],[object Object],[object Object],03/28/11 08:13 AM

? BURDEN OF SSI. ,[object Object],[object Object],03/28/11 08:13 AM

CDC Surveillance Systems 03/28/11 08:13 AM 1999-2004 1970-2004 1996-present NNIS DSN NaSH Nosocomial infections in critical care and surgical patients Bloodstream and vascular access infections in dialysis outpatients Exposure to blood borne pathogens; TB skin testing and exposure; Vaccine: history, receipt, and adverse events

What Is NHSN? N NIS NaS H D SN 03/28/11 08:13 AM Integration of CDC’s three patient and healthcare personnel surveillance systems

NHSN Premises ,[object Object],[object Object],[object Object],[object Object],[object Object],03/28/11 08:13 AM

How do we develop policy to prevent SSI? 03/28/11 08:13 AM

Healthcare Infection Control Practices Advisory Committee (HICPAC) 03/28/11 08:13 AM

Healthcare Infection Control Practices Advisory Committee MISSION ,[object Object],03/28/11 08:13 AM

Hospital Infection Control Practices Advisory Committee (HICPAC) Partial Recommendations for the Prevention of Surgical Site Infections-1999. 03/28/11 08:13 AM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Summary ,[object Object],[object Object],[object Object],[object Object],[object Object],03/28/11 08:13 AM

03/28/11 08:13 AM PREVENTION IS PRIMARY! Protect patients…protect healthcare personnel… promote quality healthcare! THANQ

Ssi ;problems&prevention

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