Surgical site infections and Role of Clinical Microbiologists
Dr.T.V.Rao MD
A post graduate question to Health care practitioners in a European University ?
Question – Describe on Epidemiology of Surgical site infections and Importance of surveillance? Every surgery done in a Hospital has accountability to patient safety and prevention of infection Majority of times the infections may occur after the discharge of the patients, to define Surgical site infections (SSIs) are defined as infections occurring up to 30 days after surgery (or up to one year after surgery in patients receiving implants) and affecting either the incision or deep tissue at the operation site. Despite improvements in prevention, SSIs remain a significant clinical problem as they are associated with substantial mortality and morbidity and impose severe demands on healthcare resources.it is just not the infection there is a changing responsibility of the Hospitals and surgeons who perform and may lead to legal challenges and compensatory claims, The causative pathogens depend on the type of surgery; the most commonly isolated organisms are Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus spp. and Escherichia coli. Numerous patient-related and procedure-related factors influence the risk of SSI, and hence prevention requires a 'bundle' approach, with systematic attention to multiple risk factors, to reduce the risk of bacterial contamination and improve the patient's defenses. The Centers for Disease Control and Prevention guidelines for the prevention of SSIs emphasize the importance of good patient preparation, aseptic practice, and attention to surgical technique; antimicrobial prophylaxis is also indicated in specific circumstances, Surgical site infections (SSI) account for 14% to 17% of all hospital-acquired infections and 38% of nosocomial infections in surgical patients. SSI remain a substantial cause of morbidity and death, possibly because of the larger numbers of elderly surgical patients or those with a variety of chronic and uncompromising conditions, and emergence of antibiotic-resistant microorganisms.
NEED TO IMPROVE THE OPERATION THEATER SAFETY - A safe and salubrious operating theater is an environment in which all sources of pollution and any micro environmental alterations are kept strictly under control. This can be achieved only through careful planning, maintenance and periodic checks, as well as proper ongoing training for staff. Indeed, an operating theater is an extraordinarily complex system in which numerous risk factors are present, including not only the features of the structure and its fixtures, but also the management and behavior of healthcare workers. (Refer to my literature on sterilization of Operation theaters on GOOGLE Search,)
Parthenogenesis of surgical site infection
The development of an SSI depends on contamination of the wound site at the end of a surgical procedure and specifically relates to the pathogenicity and inoculum of microorganism’s present, balanced against the host’s immune response Staphylococcus aureus is the microorganism most commonly cultured from SSIs. When a viscus, such as the large bowel, is opened, tissues are likely to be contaminated by a whole range of organisms. In this environment, normally non-pathogenic organisms such as Staphylococcus epidermidis (coagulase-negative staphylococcus) may also cause an SSI. Operations on sites that are normally sterile (‘clean’) thus have relatively low rates of SSI (generally less than 2%), whereas after operations in ‘contaminated’ or ‘dirty’ sites, rates may exceed 10%.7
Surveillance for surgical site infection - As to date in India there are no mandatory guiltiness or regulation to control surgical site infection we dependent mainly with CDC WHO and NIH guidelines
WHY MATTERS GO WRONG
In many cases of suspected infection: necessary cultures were not obtained, The antibiotic administration was not initiated or delayed, The choice of antibiotic was not appropriate
Surveillance of SSI provides data that can both inform and influence practice to minimize the risk of SSI, as well as communicate more clearly the risks of infection to patients. Surveillance was first recognized as an important tool in reducing rates of infection in the 1980s. The Study on the Efficacy of Nosocomial l Infection Control (SENIC) showed that surveillance and infection control programs that included the collection, analysis and feedback of data on infection rates to surgeons were associated with significant reductions in rates of SSI.. Surveillance focused on detecting SSI during the inpatient stay is thus likely to underestimate the true rate of SSI, a problem that is exacerbated by the increasing trend towards shorter lengths of postoperative hospital stay and day surgery. Therefore, systems that enable cases of SSI to be identified after discharge from hospital enhance the value of surveillance. However, there are several practical difficulties in reliably identifying SSI in community settings and methods that systematically and accurately identify SSI are required if valid comparisons of rates are to be made.
We certainly need the greater cooperation of clinical Practitioners and committed Microbiologists to reduce the morbidity and mortality in our hospital
Ref 1 Surgical site infections: epidemiology, microbiology and prevention. Owens CD, Stoessel K. J Hosp Infect. 2008 Nov;70 Pub Med
2 Surgical site infection Clinical Guideline October 2008 Funded to produce guidelines for the NHS by NICE RCOG Published by the Royal College of Obstetricians and Gynecologists.
3 CDC guidelines of Control of Surgical Site Infections
Dr.T.V.Rao MD Clinical Microbiologist On line reporter on Infectious Diseases
Dr.T.V.Rao MD
A post graduate question to Health care practitioners in a European University ?
Question – Describe on Epidemiology of Surgical site infections and Importance of surveillance? Every surgery done in a Hospital has accountability to patient safety and prevention of infection Majority of times the infections may occur after the discharge of the patients, to define Surgical site infections (SSIs) are defined as infections occurring up to 30 days after surgery (or up to one year after surgery in patients receiving implants) and affecting either the incision or deep tissue at the operation site. Despite improvements in prevention, SSIs remain a significant clinical problem as they are associated with substantial mortality and morbidity and impose severe demands on healthcare resources.it is just not the infection there is a changing responsibility of the Hospitals and surgeons who perform and may lead to legal challenges and compensatory claims, The causative pathogens depend on the type of surgery; the most commonly isolated organisms are Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus spp. and Escherichia coli. Numerous patient-related and procedure-related factors influence the risk of SSI, and hence prevention requires a 'bundle' approach, with systematic attention to multiple risk factors, to reduce the risk of bacterial contamination and improve the patient's defenses. The Centers for Disease Control and Prevention guidelines for the prevention of SSIs emphasize the importance of good patient preparation, aseptic practice, and attention to surgical technique; antimicrobial prophylaxis is also indicated in specific circumstances, Surgical site infections (SSI) account for 14% to 17% of all hospital-acquired infections and 38% of nosocomial infections in surgical patients. SSI remain a substantial cause of morbidity and death, possibly because of the larger numbers of elderly surgical patients or those with a variety of chronic and uncompromising conditions, and emergence of antibiotic-resistant microorganisms.
NEED TO IMPROVE THE OPERATION THEATER SAFETY - A safe and salubrious operating theater is an environment in which all sources of pollution and any micro environmental alterations are kept strictly under control. This can be achieved only through careful planning, maintenance and periodic checks, as well as proper ongoing training for staff. Indeed, an operating theater is an extraordinarily complex system in which numerous risk factors are present, including not only the features of the structure and its fixtures, but also the management and behavior of healthcare workers. (Refer to my literature on sterilization of Operation theaters on GOOGLE Search,)
Parthenogenesis of surgical site infection
The development of an SSI depends on contamination of the wound site at the end of a surgical procedure and specifically relates to the pathogenicity and inoculum of microorganism’s present, balanced against the host’s immune response Staphylococcus aureus is the microorganism most commonly cultured from SSIs. When a viscus, such as the large bowel, is opened, tissues are likely to be contaminated by a whole range of organisms. In this environment, normally non-pathogenic organisms such as Staphylococcus epidermidis (coagulase-negative staphylococcus) may also cause an SSI. Operations on sites that are normally sterile (‘clean’) thus have relatively low rates of SSI (generally less than 2%), whereas after operations in ‘contaminated’ or ‘dirty’ sites, rates may exceed 10%.7
Surveillance for surgical site infection - As to date in India there are no mandatory guiltiness or regulation to control surgical site infection we dependent mainly with CDC WHO and NIH guidelines
WHY MATTERS GO WRONG
In many cases of suspected infection: necessary cultures were not obtained, The antibiotic administration was not initiated or delayed, The choice of antibiotic was not appropriate
Surveillance of SSI provides data that can both inform and influence practice to minimize the risk of SSI, as well as communicate more clearly the risks of infection to patients. Surveillance was first recognized as an important tool in reducing rates of infection in the 1980s. The Study on the Efficacy of Nosocomial l Infection Control (SENIC) showed that surveillance and infection control programs that included the collection, analysis and feedback of data on infection rates to surgeons were associated with significant reductions in rates of SSI.. Surveillance focused on detecting SSI during the inpatient stay is thus likely to underestimate the true rate of SSI, a problem that is exacerbated by the increasing trend towards shorter lengths of postoperative hospital stay and day surgery. Therefore, systems that enable cases of SSI to be identified after discharge from hospital enhance the value of surveillance. However, there are several practical difficulties in reliably identifying SSI in community settings and methods that systematically and accurately identify SSI are required if valid comparisons of rates are to be made.
We certainly need the greater cooperation of clinical Practitioners and committed Microbiologists to reduce the morbidity and mortality in our hospital
Ref 1 Surgical site infections: epidemiology, microbiology and prevention. Owens CD, Stoessel K. J Hosp Infect. 2008 Nov;70 Pub Med
2 Surgical site infection Clinical Guideline October 2008 Funded to produce guidelines for the NHS by NICE RCOG Published by the Royal College of Obstetricians and Gynecologists.
3 CDC guidelines of Control of Surgical Site Infections
Dr.T.V.Rao MD Clinical Microbiologist On line reporter on Infectious Diseases
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