Infection control in the operating room: current practices or sacred cows? 1 1 No competing interests declared (original) (raw)
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In the modern day’s Oral and Maxillofacial surgical practice, complex surgical and aesthetical procedures are being carried out associated with an increased risk of infectious complications. Therefore, to ensure better outcomes of the surgical procedures, it is absolutely necessary that appropriate measures must be taken to decrease the incidence of associated infections. The practices to be carried out for infection control include proper scrubbing procedures for both patient and the operator, specific protocols to be followed by the operating personnel at the time of procedures, proper handling of the instruments and maintaining an aseptic environment throughout the procedure. The main aim of this chapter is to provide information on the preoperative, operative and post-operative protocols that should be adhered to improve the safety of the patients undergoing surgical procedures.
for the Healthcare Infection Control Practices Advisory Committee IMPORTANCE The human and financial costs of treating surgical site infections (SSIs) are increasing. The number of surgical procedures performed in the United States continues to rise, and surgical patients are initially seen with increasingly complex comorbidities. It is estimated that approximately half of SSIs are deemed preventable using evidence-based strategies.
APSIC guidelines for the prevention of surgical site infections
Antimicrobial Resistance & Infection Control
Background The Asia Pacific Society of Infection Control (APSIC) launched the APSIC Guidelines for the Prevention of Surgical Site Infections in 2018. This document describes the guidelines and recommendations for the setting prevention of surgical site infections (SSIs). It aims to highlight practical recommendations in a concise format designed to assist healthcare facilities at Asia Pacific region in achieving high standards in preoperative, perioperative and postoperative practices. Method The guidelines were developed by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published guidelines and recommendations relevant to each section. Results It recommends that healthcare facilities review specific risk factors and develop effective prevention strategies, which would be cost effective at local levels. Gaps identified are best closed using a quality improvement process. Surveillance of SSIs is recommended using accepted intern...
Global Guidelines for the Prevention of Surgical Site Infection
2016
The World Health Organization (WHO) has released new guidelines [1] for reducing health care associated infections related to surgery. The new guidelines include 29 concrete recommendations distilled by 20 of the world’s leading experts from 26 reviews of the latest evidence. The recommendations are designed to address the increasing burden of health care associated infections on both patients and health care systems globally. The guidelines include 13 recommendations for the period before surgery, and 16 for preventing infections during and after surgery. They range from simple precautions such as ensuring that patients bathe or shower before surgery and the best way for surgical teams to clean their hands, to guidance on when to use antibiotics to prevent infections, what disinfectants to use before incision, and which sutures to use.
Factors affecting surgical site infection and methods of preventing it.
According to estimates by the National Audit Office (NAO) hospital acquired infections (HAI), in particular surgical site infections (SSIs), cost the NHS on average £3200 per SSI and cause a mortality rate of at least five thousand patients a year (Leaper 2010). Despite practitioners' knowledge of safe working technique and control of infection, reported cases of nosocomial infections are still high, despite a reduction in rate from 9% in 1993/4 to 8.2% in 2006 (Roberts & Oookson 2009).
Preventing Surgical Site Infections
AJN, American Journal of Nursing, 2010
Healthcare-associated infections (HAIs) are frequent on surgical wards [1,2] and represent a high burden on patients and hospitals [1,3] in terms of morbidity, mortality, prolonged length of hospital stay and additional costs [4]. Surgical site infections (SSIs) are an important source [1] and may even be the most frequent HAI after excluding asymptomatic bacteriuria [5]. Apart from endogenous risk factors, such as immune suppression [6-8], obesity [9] or advanced age [10], the role of external risk factors in SSI patho genesis is now clearly established [1,3]. Multimodal [11], multicenter or supranational preventive intervention programs based on guidelines [1,12], 'bundles' [13,14] or safety checklists [15] are gaining momentum on a global scale [16,17]. In parallel, randomized studies provide insight into poorly explored risk factors and practical intervention measures. The National Institute for Health and Clinical Excellence (NICE) in England, Wales and Northern Ireland issued guidance for the prevention and treatment of SSI [201] in October 2008, and the 1999 SSI guidelines of the CDC are currently under revision. We summarize the state-of-the-art regarding SSI prevention among adult inpatients, highlight important epidemiological features and discuss pitfalls of surveillance and the possible role of benchmarking SSI rates. The practical questions regarding the most effective measures to reduce SSI and the SSI rates achievable today are also addressed, as well as the theoretical possibility of achieving a zero SSI policy on a surgical ward, at least for clean orthopedic surgery [3]. Methods The aim of the research was to provide an overview of the current state-of-the-art of SSI prevention with an emphasis on literature published during the last 5 years, particularly the most recent. Landmark studies and important publications are incorporated for an overriding purpose. The first author performed a PubMed search of the literature to identify English, French and German language publications prior to 10 January 2010 using the following MeSH terms in various combinations: 'surgical site infection', 'nosocomial', 'surgery', 'ortho paedic', 'infection', 'prosthesis', 'arthroplasty', 'zero', 'prophylaxis', 'prevention', 'bundles' and 'guidelines'. The search was verified by the second and last author for pertinence to the topic. Reference lists of identified articles were searched manually to retrieve additional literature published after January 2004. Animal studies and studies with an outcome other than SSI, for example, colonization studies, in vitro studies and pediatric reports were excluded. We concentrated on articles with data on the post-discharge surveillance of SSI. A total of 205 articles were retained and form the basis of this review. Sterilization
Current preventive measures for health-care associated surgical site infections: a review
Patient safety in surgery, 2014
Healthcare-associated infections (HAIs) continue to be a tremendous issue today. It is estimated 1.7 million HAIs occur per year, and cost the healthcare system up to $45 billion annually. Surgical site infections (SSIs) alone account for 290,000 of total HAIs and approximately 8,000 deaths. In today's rapidly changing world of medicine, it is ever important to remain cognizant of this matter and its impact both globally and on the individual lives of our patients. This review aims to impress upon the reader the unremitting significance of HAIs in the daily practice of medicine. Further, we discuss the etiology of HAIs and review successful preventive measures that have been demonstrated in the literature. In particular, we highlight preoperative, intraoperative, and postoperative interventions to combat SSIs. Finally, we contend that current systems in place are often insufficient, and emphasize the benefits of institution-wide adoption of multiple preventive interventions. We ...
Risk Factors and Key Principles for Prevention of Surgical Site Infections
Surgical Infections [Working Title]
Surgical site infections are one of the most important causes of healthcareassociated infections (HCAIs). They are associated with morbidity and possibly in part as a factor in associated postoperative mortality if present. Thus, it is important to recognize different SSIs and that they can vary from trivial wounds to a life-threatening condition. There are multiple risk factors contributing to the development of SSIs and guidelines to combat and decrease the possibility of the occurrence of such events through proper implementation.
Measures to Prevent Surgical Site Infections: What Surgeons (Should) Do
World Journal of Surgery, 2011
Background The present study was designed to evaluate surgeons' strategies and adherence to preventive measures against surgical site infections (SSIs). Materials and methods All surgeons participating in a prospective Swiss multicentric surveillance program for SSIs received a questionnaire developed from the 2008 National (United Kingdom) Institute for Health and Clinical Excellence (NICE) clinical guidelines on prevention and treatment of SSIs. We focused on perioperative management and surgical technique in hernia surgery, cholecystectomy, appendectomy, and colon surgery (COL). Results Forty-five of 50 surgeons contacted (90%) responded. Smoking cessation and nutritional screening are regularly propagated by 1/3 and 1/2 of surgeons, respectively. Thirty-eight percent practice bowel preparation before COL. Preoperative hair removal is routinely (90%) performed in the operating room with electric clippers. About 50% administer antibiotic prophylaxis within 30 min before incision. Intra-abdominal drains are common after COL (43%). Two thirds of respondents apply nonocclusive wound dressings that are manipulated after hand disinfection (87%). Dressings are usually changed on postoperative day (POD) 2 (75%), and wounds remain undressed on POD 2-3 or 4-5 (36% each). Conclusions Surgeons' strategies to prevent SSIs still differ widely. The adherence to the current NICE guidelines is low for many procedures regardless of the available level of evidence. Further research should provide convincing data in order to justify standardization of perioperative management.