C-section wound care management training

1. C-section wound care management training Welsh Health Associated Infection Programme (WHAIP) Public Health Wales, in conjunction with 1000 Lives Plus C-section wound care management training

2. What will be covered: • Surgical site infections • Wound care pathway (pre operative, intra operative and post operative) • Wound infection • Visual examples of SSI (healthy, superficial, deep and organ/space) • Aseptic swab procedure and hand hygiene • Surveillance • Points to take home • References C-section wound care management training

3. Surgical site infections (SSI) • Infections that occur in a wound after an invasive surgical procedure (NICE, 2008) • Mostly preventable (NICE, 2008) • They cause excess morbidity and mortality (Plowman et al., 1999) • Can double cost of treatment (Plowman et al., 1999) • Additional cost of c-section SSI £3,716 (Jenks et al., 2014) • Serious patient consequences (Coello et al., 2008) • Second most common infection after a c-section (Sykes et al., 2005) C-section wound care management training

4. Wound care pathway • Available to all Health Boards in Wales • Should be adopted for mothers undergoing elective c-section, in line with NICE guidance • NICE guidance outlined three phases • Pre-operative • Intra-operative • Post-operative • Focus on pre-operative and post-operative C-section wound care management training

5. Pre-operative C-section wound care management training

6. Intra-operative C-section wound care management training

7. Post-operative C-section wound care management training

8. How does a wound become infected? • SSIs can result from contamination of the wound site. • Skin is a natural physical barrier to micro-ogranisms, so once broken no natural protection (Patel, 2007) • Wound colonisation: The presence of bacteria within the wound but with no patient immune response (Ayton, 1985). No signs or symptoms. • Wound infection: The presence of multiplying bacteria that overwhelms the patients immune system (Kingsley, 2001). Active signs of disease present.

9. How can a wound infection be recognised? Discharge (viscous or purulent) Localised erythema Unexpected pain at dressing change Abscess Localised pain Abnormal smell Localised heat Wound breakdown Oedema Cellulitus

10. Healthy wound Likely to have some redness/moist areas C-section wound care management training

11. Superficial SSI Infection involves only skin or subcutaneous tissue of the incision • Key points • Purulent drainage should be easy recognisable • Redness (not due to inflammation around the suture) which spreads from the wound site • Cellulitis C-section wound care management training

12. Deep SSI Infection involves deep soft tissues (eg fascia and muscle layers) of the incision or another area, other than opened/manipulated during the operation, where the infection drains through the incision Key points • Similar characteristics to superficial infections • Patients with deep infections may be re-admitted • Wounds may have an abnormal smell and increased redness C-section wound care management training

13. Organ/Space SSI Involves any part of the body, excluding the skin incision, fascia or muscle layers that is opened or manipulated during the operative procedure • Key points • Usually diagnosed by a surgeon/doctor when examining or re-operating on patient C-section wound care management training

14. Summary of aseptic swab procedure • Key aspects, detailed procedure on next slide • Pre operative – hand hygiene • Take swab prior to any dressing or cleaning procedure • Sterile swab to collect exudate from the wound (collect pus in a sterile syringe) • Place specimen into sterile container • Re-wash/decontaminate hands C-section wound care management training

15. Swab sampling: wound Pre-procedure -Explain the procedure to the patient -Wash hands with soap or decontaminate with alcohol hand rub, put on apron and gloves. -Remove current dressing if applicable -Re-wash/decontaminate hands Procedure -Roll swab in ‘zig-zag’ motion over the entire wound surface -Use enough pressure to obtain fluid* from wound tissue but avoid exudates and touching wound margin -If wound dry, moisten the tip of the swab with 0.9% sodium chloride -If pus present, aspirate using sterile syringe and decant into specimen pot Post-procedure -Carefully place swab into transport tube, ensuring fully immersed in transport medium -Redress the wound, if applicable -Remove gloves and apron and discard the clinical waste. Re-wash and decontaminate hands -Complete microbiology request form -Arrange prompt delivery to microbiology labs C-section wound care management training

16. Hand Hygiene – WHO 5 moments (WHO, 2006) C-section wound care management training

17. C-Section SSI surveillance Data management Purpose of the surveillance? How is surveillance undertaken? Responsibility? C-section wound care management training

18. Points to take away • Know the Wound Care Pathway and follow it • Ensure good communication with the mother • Follow hand hygiene and asepsis techniques • Complete Public Health Wales surveillance (inpatient and post-discharge forms) C-section wound care management training

19. Slide left intentionally blank for local trainers to add notes. C-section wound care management training

20. References • Ayton in Patel, S. 2007. Understanding wound infection and colonisation. Wound Essentials, 2, 132-142 • Coello, R., Charlett, A., Wilson, J., Ward, V., Pearson, A., & Borriello, P. 2005. Adverse impact of surgical site infections in English hospitals. Journal of Hospital Infection, 60, (2) 93-103 • Centres for Disease Control and Prevention (CDC). 1988. Guidelines for Evaluating Surveillance Systems. Available: http://www.cdc.gov/mmwr/preview/mmwrhtml/00001769.htm [Accessed 24/02/2015] • Dougherty, L., & Lister, S. (Eds.). 2015. Royal Marsden Hospital Manual of Clinical Nursing Procedures (9th edition). • Gardner, S.E., Frantz, R.A., & Doebbeling, B.N. 2001. The validity of the clinical signs and symptoms used to identify localized chronic wound infection. Wound Repair and Regeneration, 9, (3) 178-186 • Humphreys, H. 2009. Preventing surgical site infection. Where now? Journal of Hospital Infection, 73, (4) 316-322 available from: http://www.sciencedirect.com/science/article/pii/S0195670109001807 • Jenks, P.J., Laurent, M., McQuarry, S., & Watkins, R. 2014. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. Journal of Hospital Infection, 86, (1) 24-33 • Kingsley, A. 2001. A proactive approach to wound infection. In: Patel, S. 2007. Understanding wound infection and colonisation. Wound Essentials, 2, 132-142 available from: http://www.wounds-uk.com/pdf/content_9407.pdf • National Institute for Health and Clinical Excellence (NICE). 2008. Surgical site infection prevention and treatment of surgical site infection. CG74 • National Institute for Health and Clinical Excellence (NICE). 2011. Caesarean section. https://www.nice.org.uk/guidance/cg132/chapter/1-guidance#/procedural-aspects-of-cs [Accessed 06/01/2015] • Patel, S. 2007. Understanding wound infection and colonisation. Wound Essentials, 2, 132-142 available from: http://www.wounds-uk.com/pdf/content_9407.pdf • Plowman, R. 2000. The socioeconomic burden of hospital acquired infection. Euro surveillance: bulletin Europeen sur les maladies transmissibles= European communicable disease bulletin, 5, (4) 49-50 • Sykes, P.K., Brodribb, R.K., McLaws, M.L., & McGregor, A. 2005. When continuous surgical site infection surveillance is interrupted: The Royal Hobart Hospital experience. American Journal of Infection Control, 33, (7) 422-427 available from: http://www.sciencedirect.com/science/article/pii/S0196655305004293 • Tanner, J., Norrie, P., & Melen, K. 2011. Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Review. Issue 11 • World Health Organisation. (2006). Five moments for hand hygiene. http://www.who.int/gpsc/tools/Five_moments/en/ [Accessed 15/12/2014]. C-section wound care management training