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Last Updated: 09/29/11 12:26:51 PM

  

Surgical Site Infection (SSI)

A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. Most patients who have surgery do not develop an infection. However, infections develop in about 1 to 3 of every 100 patients who have surgery. About 27 million surgical procedures are performed each year in the United States. A CDC estimate from 2001 suggests that approximately 290,000 surgical site infections occur every year. Approximately 8,000 patient deaths are associated with these infections

An infection is considered to be an SSI when it occurs at the site of surgery within 30 days of an operation or within 1 year of an operation if a foreign body (e.g., an artificial heart valve or joint) is implanted as part of the surgery. Most SSIs (about 70%) are superficial infections involving the skin only. The remaining infections are more serious and can involve tissues under the skin, organs, or implanted material. The majority of SSIs do not become life-threatening.

The key factors in the prevention of the SSIs are the proper surgical techniques performed by the surgical staff, as well as the general health condition of the patient. Best Practice tool provides the guidelines to reduce SSIs following the recommendations developed by CDC/ HICPAC.

 
SSI Best Practice (pdf)
 
General SSI Prevention Strategies
 

Core Measures

 

Supplemental Measures

  • Identify and treat remote infections before elective operation
  • Administer the correct agent and timing of antimicrobial prophylaxis in accordance with evidence based standards and guidelines.
  • Adjust antimicrobial prophylaxis dose for obese patients ( body mass index>30)
  • Remove hair at the operative site only when necessary and then only by clipping or depilatory agent.
  • Prepare the skin at the surgical site with an appropriate antiseptic agent.
  • Redose antibiotic at the 3 hour interval in procedures with duration >3 hours.
  • Reduce unnecessary OR traffic and keep doors closed during surgery.
  • Protect primary closure incision with steril dressing for 24- 48 hours post-op.
  • Maintain immediate postoperative normothermia.
  • Discontinue antibiotics within 24 hours after surgery end time (48 hours for cardiac)
 
  • Feedback surgeon specific infection rates.
 
Specialized SSI Prevention Strategies
     

Core Measures

 

Supplemental Measures

  • Colorectal surgery patients:
    • Mechanically prepare the colon (enemas, cathartic agents)
    • Administer non-absorbable oral antimicrobial agents in divided doses on the day before the operation.
  • Cardiac surgery:
    • Measure blood glucose level at 6 AM on POD #1 and #2 with procedure day = POD#0
    • Maintain post-op blood glucose level at <200mg/dL
 
  • Elective orthopedic and neurosurgery patients with implants
    • Nasal screen and decolonize only
      • Staphylococcus aureus carriers with preoperative mupirocin therapy.
  • Arthroplasty and spinal fusion patients
    • Screen preoperative blood sugar levels and maintain tight glucose control POD #1 and POD #2
  • Patients undergoing other select procedures
    • Use at least 50% fraction of inspired oxygen intraoperatively and immediately postoperatively

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Nevada State Health Division
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