Advances in Surgical Site Infection Prevention

1. Advances in Surgical Site Infection Prevention

2. To Receive Credit, You Must Register Deadline for Registration is May 10, 2019 Expo Mobile App Expo Evaluation Center Online http://expo.pfiedlereducation.com

3. Continuing Education Provider Funds Provided by

4. Learner Objectives • Review the impact of SSI on patients and healthcare facilities • Discuss current evidence-based recommendations related to SSI prevention • Describe advanced strategies to prevent SSI in order to deliver high-quality care, reduce costs, and promote positive patient outcomes

5. Introduction Better patient outcomes & satisfaction Increased value-based incentives Advanced SSI prevention techniques

6. Result of SSIs Patient outcomes are compromised Healthcare costs rise Reimbursement may be denied

7. Types of SSIs

8. SSI Incidence

9. Impact on Patients 3% mortality rate 75% of SSI-associated deaths directly attributed to the SSI Pain Loss of income Reduced quality of life Burden on patient and their families

10. Cost Implications $10-25k+ per infection $90k+ if prosthetic implant involved $3-10 Billion annual cost in US 1 million inpatient days per year No reimbursement for preventable conditions such as SSI

11. SSI Risk Factors • Preoperative factors • Perioperative team factors • Organizational and management factors • Patient factors • Surgeon factors • Work-environment factors • Care-delivery problems

12. SSI Prevention World Health Organization Centers for Disease Control and Prevention American College of Surgeons/Surgical Infection Society Society for Healthcare Epidemiology of America Association of periOperative Registered Nurses

13. 7 S Bundle • Safe operating room practices • Showers with chlorhexidine • Screening for MRSA and methicillin-susceptible Staphylococcus aureus (MSSA) • Skin preparation with alcohol-based antiseptics • Sutures containing an antimicrobial • Solution with chlorhexidine for irrigation • Skin adhesive and/or antimicrobial dressings to protect the incision

14. Safe Operating Room Practices • Hair clipping (no shaving) outside the operating room • Use of wound protectors to prevent tissue contamination • Careful handling of tissues by surgical staff • Disinfection of the environment during room turnovers and terminal cleaning • Safe medication-handling procedures • Safe storage of supplies • Traffic control • Limiting the number of staff in the OR during surgery • Compliance with surgical attire recommendations • Proper surgical skin scrub • Proper skin preparation with alcohol-based antiseptics • Effective sterilization of instruments • Monitoring & preventive maintenance of air-handling systems • Adequate surgical antibiotic prophylaxis • Warming of the patient before and during surgery

15. Chlorhexidine Gluconate Patient Showers  • Supported by: • CDC • ACS • AORN • WHO • SHEA

16. MRSA & MSSA Screening & Decolonization • Two options: • Screen for and treat carriers only • Universally treat everyone • Risk of worsening bacterial resistance and changing the microbiome of both the patient and the facility

17. Alcohol-Based Antiseptics for Surgical Site Prep CDC, ACS, and WHO – alcohol-based AORN – most appropriate based on patient needs WHO – specific to alcohol-based CHG

18. Intraoperative Surgical Wound Irrigation • Hydrate the wound bed • Assist in allowing better examination of the area immediately before closure • Expedite the healing process, by removing superficial and deep incisional contamination and lowering the bioburden

19. Antimicrobial-Impregnated Sutures

20. Skin Adhesives & Antimicrobial Dressings • Octyl cyanoacrylate • Polyhexamethylene biguanide (PHMB) gauze dressings • Silver dressings • Combination product consisting of: • Sterile liquid topical skin adhesive containing a monomeric 2-octyl cyanoacrylate • Self-adhering mesh

21. Skin Adhesives & Antimicrobial Dressing Results in Knee Arthroplasty • 12% reduction in length of hospital stay, • 31% reduction in probability of discharge to skilled nursing facility or other non-home setting • Reduced 30-day readmission rates (1.8%) when compared with skin staples (4.4%) • Potential cost savings of $12,839 per patient, by avoiding readmission within 30 days • Patient may be able to shower immediately • Patient may experience less pain

22. Implementation Strategies • Engagement phase • Clear and effective communication of the reasons why SSI implementation strategies are important for patient care • Education phase • Senior leadership, physicians, nurses, and patients and families are taught about practices to prevent SSI • Execution phase • Focuses on implementation strategies to reduce barriers and improve adherence to evidence-based practices • Evaluation phase • Focuses on the use of measurement and evaluation tools to determine the effectiveness of implementation strategies

23. Summary

24. To Receive Credit, You Must Register Deadline for Registration is May 10, 2019 Expo Mobile App Expo Evaluation Center Online http://expo.pfiedlereducation.com