Surgical site infections (SSI) are a major concern for ambulatory surgery centers. In the United States, the total cost attributed to healthcare-associated infections is an estimated $9.8 billion annually, according to a JAMA Internal Medicine study. The 2013 report also found that SSIs were a primary — and costly – contributor: The average price tag for an SSI is $20,785. On a per-case basis, JAMA concluded that only central line-associated bloodstream infections ($45,814) and ventilator-associated pneumonia ($40,144) were more costly to treat. The human toll on patients and their families is also great. In 2014, the U.S. Centers for Disease Control and Prevention reported that one in 25 patients “has at least one infection contracted during the course of their hospital care,” a rate in 2011 that resulted in more than 720,000 infections in 648,000 patients and 75,000 deaths. At Regent ASCs, creating positive patient experiences and outcomes are our No. 1 priority. As part of this continual commitment, it’s important to understand why SSIs occur and how they can be prevented:
Infection/contamination can occur via endogenous bacteria (i.e., from one’s own body) or exogenous bacteria (i.e., from staff or equipment). Most SSIs are caused by endogenous bacteria, and the bacteria most often identified in an infection are Staphylococcus aureus, Enterococcus and coagulase-negative Etaphylococcus. Other “bugs” such as Escherichia coli and pseudomonas also cause SSIs, but at a much lower rate. According to recent CDC data, the most common healthcare-associated infections are:
- Pneumonia (22 percent)
- Surgical site infections (22 percent)
- Gastrointestinal infections (17 percent)
- Urinary tract infections (13 percent)
- Bloodstream infections (10 percent)
According to recent CDC data, the most common germs causing healthcare-associated infections are:
- C. difficile (12 percent)
- Staphylococcus aureus, including MRSA (11 percent)
- Klebsiella (10 percent)
- E. coli (9 percent)
- Enterococcus (9 percent)
- Pseudomonas (7 percent)
SSIs are classified as being superficial incisional, deep incisional or organ-space infections. All must occur within 30 days of a surgery to be called an SSI, and they must be diagnosed as an infection by a surgeon or attending physician.
Some factors that increase the risk of a surgical patient developing an infection are age, smoking, obesity, diabetes, existing infection elsewhere on body and nasal colonization of Staphylococcus aureus.
There are a variety of effective practices for decreasing the risk of SSI in patients, including: Clip hair from the surgical site instead of shaving. Razors can cause micro-abrasions on the skin, which more easily allow endogenous bacteria to invade. The Association of Perioperative Registered Nurses recommends not removing the hair at the surgery site, if possible, as studies have shown that any hair removal can increase the risk of infection. Keep patients warm: A patient who undergoes general anesthesia should have a temperature of 36.0 C (96.8 F) or greater within 15 minutes after anesthesia end-time and within 30 minutes prior to the start of anesthesia. This means we have to think about warming in the pre-op phase, too. Even a mild hypothermia can increase the risk of infection. Antibiotics for prophylaxis should be given within one hour of cut-time. Wash your hands: This is the single most important factor in reducing the instance of exogenous bacterial infection. Encourage and educate your staff, but also remind patients or their caregivers to always wash their hands prior to performing wound care or dressing changes. There are many other measures that can affect the risk of SSI development, such as: surgical prep, patient pre-op bathing/skin disinfection, blood sugar control, sterile processing procedures, cleanliness and traffic control, pre-operative nasal decontamination of staphylococcus aureus, and proper sterile/aseptic techniques. The following is a quick quiz that can help you assess whether your staff may need further SSI training:
- Most SSIs are caused by exogenous bacteria which may come from the healthcare worker’s hands? (True/False)
- Escherichia Coli is the leading bacterial cause of SSI? (True/False)
- To help prevent an SSI, hair should be removed by shaving not clipping? (True/False)
- Hand hygiene amongst healthcare workers is the most important factor in reducing exogenous bacterial infections? (True/False)
- An obese patient who smokes may have a higher risk of developing an SSI? (True/False)
- A prophylactic antibiotic should be given within one _______ of cut time.
- Most infections are caused by __________ bacteria.
- Staphylococcus _______ is one of the leading causes of SSI.
- Infections must be diagnosed within 30 _____ of a procedure to be classified as an SSI.
- WASH YOUR ______!
It is our duty to pay attention to each of these factors to ensure our patient has a safe and successful surgical experience. For more information on SSIs, please contact firstname.lastname@example.org.