Author: Dr. Abhishek Sinha, Quality Systems, Apollo Hospitals.

According to research, the percentage of patient deaths reported due to surgical site infection is 77%among all surgical patients. Therefore it becomes the most important issue to address in order to improve patient safety[1].

The preventive actions could be grouped under three phases of surgical care viz. pre operative care, intra/peri-operative care and post operative care:

Pre-operative Care

  • The compliance toantimicrobial prophylaxisprotocol for the type and the time of administration.

The appropriate prophylactic antibiotic could be selected on the basis of:

a)The complexity of surgical procedure

  1. b) Most common SSI pathogens prevailing for the planned procedure
  2. c) Known allergies or drug reactions of each specific patient.
  3. d) Any published recommendations
  • The decision to remove hair at the operating site should be justifiable.
  • An appropriate antiseptic agent and technique for skin preparation, preferably an alcohol containing preparation to be used.
  • Patient should be instructed to stop smoking 4 to 6 weeks before surgery.

Intra-operative:

  • To maintain intra-operative and postoperative normothermia(to maintain the body temperature of ≥36C).
  • The doorsof operating rooms should be kept always closed during surgery. These doors should only be opened when any equipment is required or any personnel/staff is required.
  • The operating room should be maintained under “positive pressure” (maintaining the appropriate number of air changes and the type of air flow).
  • WHO Safe Surgical Checklistshould be followed strictly in order to rule out any foreign body/swab retention at the surgical site.

Postoperative:

  • The primary closure incisions should be protected with sterile dressing.
  • To comply with discontinuation of antibiotics within 24 hours after the surgical site closure (48 hours for cardiac patients). The only deviation from this practice could only be when signs of infection are evident.
  • To design and implement patient centric metrics which measures patient outcomes. The results of this monitoring should be discussed and reviewed at various committee meetings or other equivalent clinical forums involving the surgical team[2].
  • SSI follow up should be implemented and all the operated patients should be tracked within the window period for any signs of surgical site infection.
  • The patients and families should be adequately informed and educated on how to prevent any occurrence of surgical site infection.

Despite the remarkable developments in the use of surgical techniques, ergonomic advancements in the operating room and implementation of bundles, surgical site infections (SSIs) remain a substantial burden. These hospital acquired infections not only increase morbidity and mortality but also contribute heavily on healthcare costs. SSI improvement the programs require an integrative approach with measures taken during the pre-, intra- and postoperative care from the numerous stakeholders involved.

As discussed above, the importance and influence of patient participation is becoming an increasingly important concept and advocated as a means to improve patient safety.Empowering patients with information they require to engage in the process of SSI prevention could play a major role for the implementation of recommendations [3].

Research has shown that the percentage of morbidity/mortality among patients who were properly educated about their health and who participated in decision making about their care was lower than those who did not participate[4].

REFERENCES

  1. http://www.patientsafetyinstitute.ca/en/Topic/Pages/Surgical-Site-Infection-(SSI).aspx
  2. https://patientsafetymovement.org/actionable-solutions/challenge-solutions/healthcare-associated-infections-hais/surgical-site-infections-ssi/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5427557/
  4. https://www.jointcommission.org/podcast.aspx

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