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Prevention of Surgical Site Infections (SSIs)

Prevention of Surgical Site Infections (SSIs). Dr. Bennet Rajmohan, MRCS (Eng), MRCS (Ed) Consultant General Surgeon. 1. Pre-operative shaving. Avoid pre-op shaving totally If shaving must, it should be done on the operating table Hair clippers preferable

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Prevention of Surgical Site Infections (SSIs)

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  1. Prevention of Surgical Site Infections (SSIs) Dr. Bennet Rajmohan, MRCS (Eng), MRCS (Ed) Consultant General Surgeon

  2. 1. Pre-operative shaving • Avoid pre-op shaving totally • If shaving must, it should be done on the operating table • Hair clippers preferable • Depilatory creams to be stocked in pharmacy. To be used for fine body hair in children & women  train staff nurses • ? All razors banned from hospital – barbers to use some for usual facial shaving for male patients, if requested

  3. 2. Prophylactic antibiotics • Antibiotic policy for specific surgeries to be written in consultation with surgeons • Only test doses (if necessary) to be administered in ward. Full dose to be given at or just before induction of anaesthesia, to ensure maximum blood levels at the time of skin incision. 2nd dose for prolonged surgery • Sincere effort to stop prophylactic antibiotics at the earliest, preferably within 24 to 48 hours

  4. 3. Antiseptics • Pre-op skin prep – 2% Chlorhexidene better than povidone-iodine in clean contaminated surgery (metaanalysis, 5031 pts, 5.7% vs 7.9%) • Povidone-iodine intracavitary lavage – lesser SSI ( 24 RCTs, 5004 pts, 8% vs 13.4%) • Alcohol hand rub as good as soap & water for surgical hand preparation ( RCT, Kenya, 3317 pts, clean or clean contaminated surgery, SSI rate 8% in both , 94.5% 30-day follow-up)

  5. Antiseptics vs antibiotics • For management of chronic wounds • Lesser bacterial resistance, cheaper, over the counter • Best evidence for silver. Others – povidone-iodine, chlorhexidene. Avoid hydrogen peroxide & sodium hypochlorite • Vinegar, honey

  6. 4. Intraoperative normothermia • Conscious effort by surgeons to ensure non-operative field well insulated – caps, booties, dry sheets, thermal blankets, cotton rolls & bandages • Avoid spilling of skin preparation fluids, peritoneal cavity irrigation fluids onto patient’s sheets – wet sheets lower body temp, alcohol containing fluids fire hazard & cause diathermy burns • Wipe patients dry after surgery

  7. 5. Supplemental Oxygen • FiO2 80%, reducing nitrous oxide, especially in colorectal cases

  8. 6. Hand hygiene • Part of Infection control nurses’ work to teach nurses, doctors • Handrub to be offered to doctors before & after patient contact • Handrub to be available at all bedsides or at entrance to each room.

  9. 7. Active infection surveillance • Infection control nurse or representative in each ward to inspect all surgical wounds, at the time of dressing • To report any infection to doctor collecting data / respective consultants • To follow culture results & advise isolation precautions for MRSA etc • Digital photographs of wound infections to be displayed in respective Operation theatres for OT staff feedback

  10. 8. Post discharge surveillance • To arrange routine review of operated patients at 1 month or 1 year ( if implant present) • To arrange follow-up as above for general surgical patients under surveillance since July 2008

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