Week 13 - Topic 2: Surgical Site Infections Flashcards
What is the most common healthcare associated infection?
Surgical site infection (SSI)
Where is a superficial incisional SSI?
Skin + subcutaneous tissue
Where is a deep incisional SSI?
Deep soft tissue (muscle and fascia)
Where is an organ/space SSI?
In the organ space
The majority of interventions that reduce SSI are implemented:
1) Before and during surgery
2) After surgery
3) Both
Answer: 1) before and during surgery
Why should someone stop smoking weeks before surgery?
To reduce pulmonary complications
What should be done prior to surgery?
- Nutrition: assess for malnutrition and albumin levels
- Admission prior to surgery should be minimized
- Identify and treat infections prior to surgery
- Maintain glucose control before/during/after surgery
- Screen for nasal carriage of Staph aureus and decolonize known carriers before implant procedures
- Remove hair with clippers only if it interferes with surgery as close to the time of surgery
- Shower PT with CHG or CHG wipes
- Hand hygiene with CHG
- Time out to validate right PT, surgery, site
With regards to nutrition, who is at risk for SSI?
- BMI < 19
- Unintentional weight loss > 8 lbs in 3 months
- Poor appetite (less than 2 meals/day)
- Dysphagic
- Vomiting
Why should admission prior to surgery be minimized?
To reduce the risk of acquiring MDRO or other infections
Why should you treat an infection before surgery?
To reduce the possibility of seeding the operative site from the remote infection
Who should have glucose control being done?
- Diabetics
- > 45 y.o.
- BMI >= 30
- Undergoing high risk surgery (ex: cardiac)
- BG > 8-10 mmol/L or > 150-180 mg/dL
- Abnormalities of monocyte and polymorphonuclear neutrophil function
Your PT has a fasting blood glucose level of > 8-10 mmol/L or > 150-180 mg/dL prior to surgery. What do you do?
Suggest use of insulin drip during OR or immediately after
How do you decolonize nasal carriers of Staph aureus?
- CGH skin prep and nasal mupirocin
- MRSA: vancomycin
- Non-MRSA: cefazolin
How do you do antiseptic skin prep?
- Shower with CHG detergent or paint CHG solution minimally the night before and the morning of surgery
- CHG wipes applied consecutively for 3-5 days before surgery
How should the team scrub for surgery?
–Maintain short nails ( < 3mm) –Clean under fingernails –Scrub from hands to elbows using CHG –Time scrub 2-5 minutes (or according to manufacturer's directions) –Hold hands up after surgical scrub
