1 / 30

Surgical Site Infections: The Foundation

Surgical Site Infections: The Foundation. What Are We Doing Together Over the Next Two Months. Talk about ways to prevent surgical site infections and venous thromboembolism in surgical patients.

ivie
Download Presentation

Surgical Site Infections: The Foundation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Surgical Site Infections:The Foundation

  2. What Are We Doing Together Over the Next Two Months • Talk about ways to prevent surgical site infections and venous thromboembolism in surgical patients. • Webinars every two-weeks where we will discuss methods that appear in the literature and that are “low-hanging fruit”. • The topics that we discuss are things that: • will make the most difference to your patients • have clear evidence • are things that you can put into place in your ORs

  3. We Will Not Go Into Step-By Step Instructions On How To Put These Methods Into Place

  4. Today’s Topics • Brief History of Infection Prevention Techniques • Prophylactic Antibiotic Administration • Weight Based Dosing • Re-dosing • Discontinuing Antibiotics

  5. Common Sense Science • Bacteria cause infection • Bacteria are everywhere • It is a battle against the bacteria

  6. Brief History of Infection Prevention IgnazSemmelweiss Joseph Lister Louis Pasteur

  7. Surgery – 1969 Postoperative Wound Infection: A Prospective Study of Determinant Factors and Prevention Polk HC Jr, Lopez-Mayor JF

  8. Surgical Technique, Prophylactic Antibiotics and SSI Polk. Surgery 1969;66:97-103

  9. Different Ways of Preventing SSI’s OR Traffic Bowel Prep Temperature Control Transfusion Maintenance of hemostasis and perfusion Wound Protectors Communication Teamwork • Pre-operative screenings • Proper Hair Removal • Skin Prep • Hair Prep • Hand Hygiene • Prophylactic Antibiotics • Surgical Technique • Glucose Control • Hyperoxia

  10. Preventing SSI’s

  11. Rates of Surgical Site Infection and Benefit From Prophylactic Antibiotics Dellinger, Patchen 2013. Hospital Engagement Network

  12. Common Sense Science: Timing of Antibiotics • In order for antibiotics to be effective they need to be in the tissue at the time that the incision is made. • It can take more time to reach some tissues than others. • Antibiotics can’t get to tissue that has no blood flow.

  13. Perioperative Prophylactic AntibioticsTiming of Administration 14/369 15/441 1/41 1/47 1/81 Infections (%) 2/180 5/699 5/1009 Hours From Incision Classen. NEJM. 1992;328:281.

  14. Common Sense Science:Weight Based Dosing • Larger patients have more tissue and larger blood volumes. • Standard antibiotics doses given to larger patients will result in lower blood and tissue levels of antibiotics. • The dose of prophylactic antibiotic should be adjusted for larger patients.

  15. Obesity Map

  16. Prophylactic Antibiotics:Size of Patient and Size of Dose • Morbidly obese patients having bariatric surgery have higher infection rates. • Cefazolin levels are lower in obese patients than in non-obese patients at same dose. • Cefazolin dose changed from 1 g to 2 g: • Infection rate at 1g: 16.5% • Infection rate at 2g: 5.6% Forse RA. Surgery 1989;106:750

  17. Ancef • Pediatric Dosing: • 25 – 50 mg/kg/day divided into three doses • 70kg x 50 = 3500 • 3500/3 = ~1000 or 1 gram • 100kg x 50 = 5000 • 5000/3 = ~ 1700 or 2 grams

  18. Recommended Adult Dosing • < 80 kg -------- 1 gram • > 80 kg -------- 2 grams

  19. Common Sense Science: Antibiotic Re-dosing • The blood level of all antibiotics decreases with time. • When the level falls enough, the infections “fighting power” of the antibiotic is no longer effective. • A second [or third] dose of antibiotics should be given to prevent surgical site infection.

  20. Results When You Re-Dose Antibiotics

  21. How Long Between Re-Dosing? • It turns out that if antibiotics are re-dosed they can remain clinically effective. • There is probably some variability in this [different surgical procedures can change drug metabolism]. • Other factors can decrease this interval.

  22. Common Sense Science: Discontinuing Prophylactic Antibiotics • The primary effect of giving antibiotics during surgery comes from the initial dose given before the incision and additional doses given while the incision is open. • That is when most of the bacteria contamination occurs. • Additional doses of antibiotics given after the wound is closed have minimal or no effect on the development of surgical site infections.

  23. Antibiotic Resistance is a Big Problem NEJM: Pallares et al. Vol. 333:474-480.

  24. Staphylococcus Aureus Emerging Infectious Diseases: Vol.7 No. 2. Chambers, H.F.

  25. Vancomycin

  26. Take Home Messages • This is hard. • The GREATER GOOD. • My patient.

  27. ? Questions

  28. Upcoming Calls • Thursday, May 16th 2:00-2:45: The Impact of Communication, Teamwork, and Culture on SSI’s. • Thursday, May 30th 2:00-2:45: Preventing SSI’s When Preparing Our Patients for Surgery

  29. Office Hours:Wednesday 2:00-3:00

  30. Resources Website: www.safesurgery2015.org Email: safesurgery2015@hsph.harvard.edu

More Related