surgical site infection prevention: how are we doing and what's what in who's new...
TRANSCRIPT
2%
2%
2%
2%
3%
3%
4%
4%
4%
5%
5%
5%
6%
7%
9%
10%
18%
19%
Cerebrovascular Accident
Cardiac Pulmonary Resuscitation
Renal Insufficiency
Acute Renal Failure
Pulmonary Embolism
Deep Vein Thrombosis
Wound Disruption
Septic Shock
Myocardial Infarction
Deep SSI
Unplanned Intubation
Ventilators 48h
Organ SSI
Sepsis
Post-op Death in 30 days
Pneumonia
Superficial SSI
Urinary Tract Infection
Type of Post-Op Outcomes
Any SSI: 29% Any Sepsis: 10% Respiratory: 10% DVT/PE: 6% Cardiac: 6% Renal: 4%
1.2%
1.5%
1.5%
1.7%
2.4%
2.8%
3.2%
4.6%
4.9%
6.6%
Urology
Orthopedics
Neurosurgery
Otolaryngology (ENT)
Gynecology
Thoracic
Plastics
Vascular
General Surgery
Cardiac
Surgical Site Infections by Specialty
226 of 3,440
2,616 of 52,953
234 of 5,121
364 of 11,301
61 of 2,190
426 of 17,538
130 of 7,663
86 of 5,787
730 of 49,157
241 of 20,820
WHO Guidelines
Adult Surgical Patients
Some Guidelines are for Special Populations
Pre/Intra/Post Operative
Things we already do…
Pre-Operative
• Bathing
• Hair Removal
• Surgical Site Prep
• Antibiotic Prophylaxis
Things we already do…
Post-Op
• Discontinue prophylactic antibiotics
• Remove drains when clinically indicated
Surgical Site Infections A Surgeon’s Perspective
Dr. David E. Konkin, MD, FRCSC, FACS
General Surgeon Royal Columbian Hospital/Eagle Ridge Hospital
RCH
! Trauma, Cardiac, Neuro, High-risk Maternity/Neonatal ICU
! General Surgery, Trauma, Colorectal, Hepatobiliary, Surgical Oncology
! Tertiary Centre for FHA
NSQIP (National Surgical Quality Improvement Program)
! Second hospital in Canada to join NSQIP (1st was Surrey Memorial Hospital)
! Joined 2006
! ERAS since 2007 (before it was called ERAS)
WHO Guidelines
! World Assessment
! Stress surveillance (most do not have NSQIP)
! Basic cleaning
! Pre/Intra/Postop
Highlights
Wound protector
Negative pressure wound therapy
Intense glucose control
Mechanical bowel prep with Abx
Perioperative 02 supplementation
0
0.5
1
1.5
2
2.5
3
3.5
4
Odd
s Ra
tios
Monthly Period
Eagle Ridge Hospital All Cases Surgical Site Infections Risk Adjusted Projected Odds Ratio (OR) Report,
December 1, 2014 - November 30, 2016
SSI ORs
Trendline for ORs
Target OR = 1 or less