SURGICAL SITE INFECTION PREVENTION
Shannon Pienkowski
Julita Soliszko
Sally Tecpanecatl
BACKGROUND
A hospital is working on reducing surgical cite infections (SSI) for knee and hip replacement patients. The SSI rate for knee replacements last year was 11.2% and the SSI rate for hip replacements was 16.3%. They want to reduce the numbers to zero.
The process is as follows: The patient is scheduled for surgery, they are required to attend a 2-hour educational session pre-operatively, they are informed the night before of the time to be at the hospital and to take a shower on the day of surgery but no not scrub at the surgical site.
On the day of: the patient is placed onto a pre-op bed, given information about the surgery, is visited by the surgeon and the anesthesiologist, and asked to sign a consent form.
Surgical Site Infection Prevention
BACKGROUND CONT.
During surgery, the surgeon cleanses the site and creates a sterile field. After closing the site, a dressing is placed on the surgical site and the patient is later informed not to change the dressing for one week.
The patient is given a new dressing to replace the old one.
The patient is allowed to shower but has to keep the surgical site dry by using plastic wrap and tape.
All patients are sent home with instructions about what to watch for and when to call the physician or come to the emergency room (e.g., temperature over 100 degrees, redness or soreness at the site, cold leg).
Surgical Site Infection Prevention
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DOES THE USE OF A SURGICAL SITE INFECTION BUNDLE HELP PREVENT OR REDUCE SURGICAL SITE INFECTIONS IN PATIENTS RECEIVING TOTAL HIP OR KNEE REPLACEMENTS?
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PICO question
ANALYSIS OF PROBLEM
On the PNWOSC unit there are many surgical site infections compared to other units.
SSI RATES
Surgical Site Infection Prevention
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FISHBONE DIAGRAM
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Surgical Site Infection Prevention
ACTION PLAN TO PREVENT SSI
Surgical Site Infection Prevention
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INDICATORS
Surgical Site Infection Prevention
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2-hour educational session
A 10-question quiz will be administered to the patients regarding the information learned from the session
WHO: RN in charge of the class and administering the quiz
WHAT: Assess the need to educate patients on surgical site infection prevention and what signs and symptoms to look for
WHERE: In the preoperative surgical unit or classroom
WHY: To help reduce the risk of developing a surgical site infection
WHEN: The day of taking the quiz, the patients will be educated on what they missed
HOW: Reviewing the quiz
Showering or bathing with skin antiseptics can help reduce SSIs (Tsai and Caterson, 2014).
Pt acknowledging the risk and benefits of not showering using skin antiseptics.
WHO: The nurses in charge of making phone calls the day before surgery.
WHAT:
Make sure the patient knows the education (why) behind the reason to shower.
WHERE: At home before arriving to the hospital the day of surgery.
WHY: To reduce the risk of surgical site infection.
WHEN: The day of the scheduled surgery.
HOW: Making a note in the patient’s EMR stating verbatim whether they were or were not compliant with the antiseptic shower.
INDICATORS CONT.
Surgical Site Infection
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Administration of prophylactic antibiotics (Aginga, 2022)
Administering the antibiotics approx. 120 minutes before the incision is made and considering the half-life of the antibiotic can reduce the risk of SSI (Tsai and Caterson, 2014.
WHO: Unit Nurse Manager
WHAT: Implement a protocol to administer antibiotics, depending on their half-life, prior to the time of the incision.
WHERE: In the preoperative surgical unit and inpatient surgical unit
WHY: To help reduce the risk of developing a surgical site infection
WHEN: Within 30 days
HOW: Auditing charts
Pre-operative surgical site scrub and technique
Surgeons use appropriate technique for pre-operative surgical site scrub
WHO: Surgeons
WHAT:
Scrubs the surgical incision site in accordance with the hospital protocols
WHERE: In the OR
WHY: To reduce the risk of surgical site infection postopeatively
WHEN: Within 30 days of protocol implementation
HOW: Auditing charts
AREAS OF FOCUS
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PATIENT EDUCATION
Educate patients from the moment they decide that it is time for a hip or knee replacement
Educate them on the importance of preventing infection beginning with the shower at home to the day of discharge
Make sure the patients are able to attend any educational session regarding their surgery
SURGICAL SITE INFECTION PREVENTION
Adjust protocols accordingly
Continue to use the best available evidence for guidance regarding administration of antiobiotics
Educate staff on the prevention of surgical site infection
REFERENCES
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Aginga, C. (2022). Surgical site infection: Preoperative evaluation and preventative measures [PDF]. The JBI
EBP Database. https://ovidsp-dc2-ovid-com.pnw.idm.oclc.org/ovid-b/ovidweb.cgi?
&S=EICLFPLPOGEBPPGAIPMJBGLENLKCAA00&Link+Set=S.sh.41%7c3%7csl_190
Tsai, D.M., Caterson, E.J. Current preventive measures for health-care associated surgical site infections: a review. Patient Saf Surg 8, 42 (2014). https://doi.org/10.1186/s13037-014-0042-5
Surgical Site Infection Prevention
THANK YOU
Shannon Pienkowski
Julita Soliszko
Sally Tecpanecatl
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