Assess risk for SSI in patients, procedures
Despite advances in infection control in operating rooms, surgical site infections (SSIs) remain a substantial cause of morbidity and mortality among hospitalized patients, the Centers for Disease Control and Prevention reports.
Surgical site infections are the third most frequently reported nosocomial infection, accounting for 14% to 16% of all nosocomial infections among hospitalized patients, the CDC notes.1 During 1986 to 1996, CDC sentinel hospitals followed 593,344 operations and found that 15,523 (2.6%) were complicated by an SSI. Of those SSIs, two-thirds were confined to the incision, and one-third involved organs or spaces accessed during the operation. When surgical patients with nosocomial SSIs died, 77% of the deaths were reported to be related to the infection. The majority of fatal infections involve organs or spaces accessed during the operation.
Continuing problems with SSIs may be explained in part by increasing severity of illness in elderly, immune-compromised patients and the emergence of antimicrobial-resistant pathogens. In that regard, the new CDC SSI guidelines emphasize that routine use of vancomycin — a last-line drug facing dwindling efficacy against some pathogens — is not recommended as prophylaxis for any kind of operation. However, vancomycin prophylaxis may be appropriate in certain clinical circumstances, such as when a cluster of methicillin-resistant Staphylococcus aureus mediastinitis has been detected.
"We thought it was only prudent that we speak to this issue, especially in regard to vancomycin," says Alicia Mangram, MD, lead author of the guidelines while at the CDC hospital infections program and now in surgical residency at the University of Texas in Houston. "[We] tried to make a strong statement that we don’t want to have surgeons overusing prophylactic drugs."
Overall, the guidelines emphasize basic infection prevention principles and minimizing risk where possible, she notes. "Prior to planning an elective operation, look at the risk factors that we have mentioned and see if there is anything that can be done to change them," she recommends. While ICPs should consult the CDC SSI guidelines for specific guidance on particular factors, the following were listed as the prime characteristics that can contribute to SSI development:
• Patient risk factors: Age, nutritional status, diabetes, smoking, obesity, coexistent infections at a remote body site, colonization with micro organisms, altered immune response, and the length of preoperative stay.
• Operation risk factors: Duration of surgical scrub, skin antisepsis, preoperative shaving, preoperative skin prep, duration of operation, antimicrobial prophylaxis, operating room ventilation, inadequate sterilization of instruments, foreign material in the surgical site, surgical drains, surgical technique (i.e., poor hemostasis, failure to obliterate dead space, tissue trauma).
Reference
1. Mangram AJ, Horan TC, Pearson ML, et al. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999; 20:257-280.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content