Hygienic care of the patient before surgery BARN 3rd Workshop, 1-2 October 2012, Sweden

1. Hygienic care of the patient before surgeryBARN 3rd Workshop, 1-2 October 2012, Sweden Hospital of Lithuanian University of Health Sciences Kauno Klinikos Institute of Hygiene dr.G.Gailiene

2. Structure • 21 buildings (area123732,70 m2) • Number of profiled medical departments– 34 • Subsidiaries –4 (Oncology hospital, TB hospital, rehabilitation hospitals –child and adults) • Total number of beds(with subsidiaries)–2605 • Total number of staff–6229

3. Number of surgical procedures

4. Prevalence of HCAI inHospital of Lithuanian University of Health Sciences Kauno Klinikos

5. Prevalence of HCAI according to site (%)in Hospital of Lithuanian University of Health Sciences Kauno Klinikos 2012

6. Prevalence of HCAI according to site in Lithuanian acute care hospitals(%)(Institute of Hygiene, 2010)

7. Prevalence of HCAI according to site in EU (%)(prevalence studies in EU counties 1990-2007)* * http://www.ecdc.europa.eu/en/publications/Publications/0706_SUR_Annual_Epidemiological_Report_2008.pdf

8. Recommendations/guidelines • Patient preparation for surgery procedure: • Country – recommendations; • Hospital – work instructions;

9. Methods • Cross-sectional studies: • 2009 -140 patients; • 2012 – 66 patients; • Departments: • 13 surgery (excluding ENT, eye); • 2 ICU: general (medical/surgery), cardiology; • 3 therapy: cardiology, gastroenterology, nephrology.

10. Category IA - strongly recommended for implementation and supported by well- designed experimental, clinical, or epidemiological studies. • If hair is removed, remove immediately before the operation, preferably with electric clippers. Category IA

11. Hair Removal

12. Method of hair removal Electric clippers – 0.0%

13. Category IB - strongly recommended for implementation and supported by some experimental, clinical, or epidemiological studies & strong theoretical rationale. • Require patients to shower or bathe with an antiseptic agent on at least the night before the operative day. Category IB

14. Patient shower or bath (PH -patient hygiene)

15. Changing of patient clothes and bed linen • 2009: • 9 patients were bathed night before surgery, • clothes and bed linen changed on surgery day; • 8 patients were bathed, bed linen wasn’t changed. • For 2 patients bed linen was changed night before surgery, bathed on the surgery day; • 1 patient wasn’t bathed, bed linen changed on surgery day.

16. Category II - Suggested for implementation and supported by suggestive clinical or epidemiological or theoretical rationale • Keep preoperative hospital stay as short as possible while allowing for adequate preoperative preparation of the patient. Category II Preoperative hospital stay (days) • 2009 - 1.2 (0.7 – 2.6) • 2012 – 1.1 (0.6 – 3.1)

17. Category IA - strongly recommended for implementation and supported by well- designed experimental, clinical, or epidemiological studies. • Administer by the intravenous route the initial dose of prophylactic antimicrobial agent, timed such that a bactericidal concentration of the drug is established in serum and tissues when the incision is made... Category IA • In 2009 and 2012 – 100, 0% patients received antimicrobial agent i/v ≤ 1 - 0 h before incision.

18. Summary • Decreased cases of hair removal night before surgery (2009 - 5.7% vs. 2012 - 1.5%); • Main method of hair removal remain shaving, clippers are not used; • In 2012 all patients were bathed and was changed bed linen/clothes on surgery day; • In general hygienic care of the patients before surgery improved, but SSI rate does not decreased.

19. Thank you for attention