Strategies to Prevent Surgical Site Infections in Acute Care Hospitals

Abstract

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals to implement and prioritize their surgical site infection (SSI) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion.1. Burden of SSIs as complications in acute care facilities.a. SSIs occur in 2%-5% of patients undergoing inpatient surgery in the United States.b. Approximately 500,000 SSIs occur each year.2. Outcomes associated with SSIa. Each SSI is associated with approximately 7-10 additional postoperative hospital days.b. Patients with an SSI have a 2-11 times higher risk of death, compared with operative patients without an SSI.i. Seventy-seven percent of deaths among patients with SSI are direcdy attributable to SSI.c. Attributable costs of SSI vary, depending on the type of operative procedure and the type of infecting pathogen; published estimates range from $3,000 to $29,000.i. SSIs are believed to account for up to $10 billion annually in healthcare expenditures.1. Definitionsa. The Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System and the National Healthcare Safety Network definitions for SSI are widely used.b. SSIs are classified as follows (Figure):i. Superficial incisional (involving only skin or subcutaneous tissue of the incision)ii. Deep incisional (involving fascia and/or muscular layers)iii. Organ/space

Recomendaciones prácticas para la antisepsia de la piel del paciente antes de cirugía

“…En aquellos pacientes que presenten vello que dificulte la cirugía se procederá solo a cortar el vello, jamás rasurar al ras con una cuchilla de afeitar, dado que este procedimiento incrementa el riesgo de ISO. -Para el corte del vello este se debe hacer mediante el uso de una maquina cortadora de vello o por medio de un agente depilatorio, que no generan abrasiones a la piel (Grado de recomendación A I) 5,22,27,28 . Sin embargo, se deben tener en cuenta que las cremas depilatorias pueden causar quemaduras química o hipersensibilidad.…”

“…A continuación, se describen de manera práctica los aspectos más relevantes de esta preparación a manera de protocolo, con el fin de actualizar y unificar la práctica en nuestro medio. En este documento se hace énfasis en aquellas recomendaciones que en la literatura tienen un grado de recomendación fuerte, a pesar de que son tomadas de diferentes fuentes, se unificaron las recomendaciones basadas en la clasificación propuesta por Anderson DJ et al 22 . Brevemente, la fortaleza de la recomendación se clasificó de A hasta C, siendo A, una recomendación con buena, B con moderada y C con pobre evidencia para respaldar su uso.…”

Impact of preoperative myocardial infarction on surgical outcomes in inpatient orthopaedic surgery

“…Approximately 500,000 occur in the US annually at an estimated total cost of ten billion dollars; each SSI is associated with seven to ten additional postoperative hospital days and a two to 11 times higher risk of death [17]. Various risk factors correlate with SSI.…”

Practical Recommendations for Preoperative Skin Antisepsis

“…The most relevant aspects of this preparation are described in a practical way are described as follows, to update and unify the practice in our context. This paper emphasizes those recommendations with a strong recommendation level in the literature, although they are taken from different sources, they were unified based the on the classification proposed by Anderson DJ et al 22 .…”