Prevention of healthcare associated (nosocomial) infection : Safer surgery overview of strategies

Size: px

Start display at page:

Download "Prevention of healthcare associated (nosocomial) infection : Safer surgery overview of strategies"

Easter Hancock
8 years ago
Views:

1 Prevention of healthcare associated (nosocomial) infection : Safer surgery overview of strategies Assoc. Professor John Ferguson May 2011 jferguson@hnehealth.nsw.gov.au Also see Prof A Widmer WHO Webinar on this topic, some of his material has been used in this presentation.

Professor John Ferguson May 2011 jferguson@hnehealth.nsw.gov.au www.

2 Burden of major infections worldwide MALARIA N annual episodes: mio N annual deaths: mio 90 countries at risk worldwide TUBERCULOSIS N new infections/year: 8 mio N deaths in 2005: 1.6 mio 1/3 of the world currently affected HIV N affected: 39.5 mio N new infections/year: 4.3 mio N deaths in 2006: 2.9 mio Most countries affected with different infection rates HEALTHCARE-ASSOCIATED INFECTIONS Hundreds of millions of patients affected each year At any time, n affected in hospitals: over 1.4 mio N deaths/day: N deaths/year: 50 mio ALL countries affected

6 mio 1/3 of the world currently affected HIV N affected: 39.5 mio N new infections/year: 4.3 mio N deaths in 2006: 2.

3 Adverse Events in Hospitals Most Frequent Categories Non-surgical Surgical Brennan. N Engl J Med. 1991;324:

4 Infection prevention in surgery: priorities 1. WHO Safe surgery Saves Lives (World Alliance for Patient Safety); Safer Surgery Checklist 2. Surgical site infection surveillance- you can only improve what you measure! See separate materials. 3. Effective disinfection of surgical operation sites with alcohol-based preparations; 4. Antibiotic prophylaxis best practice. See separate materials. 5. Hand hygiene by healthcare staff and surgeons (WHO 5 Moments Standard)- see separate talk and Prof Widmer s talk 6. Improvements to recognition treatment of sepsis and post operative infection (see Sepsis)

Effective disinfection of surgical operation sites with alcohol-based preparations; 4. Antibiotic prophylaxis best practice. See separate materials. 5.

6 WHO s 10 Objectives for Safe Surgery 1. The team will operate on the correct patient at the correct site. 2. The team will use methods known to prevent harm from administration of anaesthetics, while protecting the patient from pain. 3. The team will recognize and effectively prepare for lifethreatening loss of airway or respiratory function. 4. The team will recognize and effectively prepare for risk of high blood loss. 5. The team will avoid inducing an allergic or adverse drug reaction for which the patient is known to be at significant risk.

The team will recognize and effectively prepare for lifethreatening loss of airway or respiratory function. 4.

7 WHO s 10 Objectives for Safe Surgery 6. The team will consistently use methods known to minimize the risk for surgical site infection. 7. The team will prevent inadvertent retention of instruments or sponges in surgical wounds. 8. The team will secure and accurately identify all surgical specimens. 9. The team will effectively communicate and exchange critical information for the safe conduct of the operation. 10. Hospitals and public health systems will establish routine surveillance of surgical capacity, volume and results.

The team will prevent inadvertent retention of instruments or sponges in surgical wounds. 8.

10 Infection prevention in surgery: priorities 1. WHO Safe surgery Saves Lives (World Alliance for Patient Safety); Safer Surgery Checklist 2. Surgical site infection surveillance- you can only improve what you measure! See separate materials. 3. Effective disinfection of surgical operation sites with alcohol-based preparations; 4. Antibiotic prophylaxis best practice. See separate materials. 5. Hand hygiene by healthcare staff and surgeons (WHO 5 Moments Standard)- see separate talk and Prof Widmer s talk 6. Improvements to recognition treatment of sepsis and post operative infection (see Sepsis)

11 Surveillance : data for action A guide to using data for health care quality improvement Victorian Quality Council 2008

12 Surveillance : data for action A guide to using data for health care quality improvement Victorian Quality Council 2008

13 Key references: surgical site infection surveillance Separate presentation (Ferguson) National Hospital Safety Network SSI definition (accepted international standard) Surveillance of SSI Australian review 2008 A Widmer WHO Webinar 2010

Network SSI definition (accepted international standard)

14 Infection prevention in surgery: priorities 1. WHO Safe surgery Saves Lives (World Alliance for Patient Safety); Safer Surgery Checklist 2. Surgical site infection surveillance- you can only improve what you measure! See separate materials. 3. Effective disinfection of surgical operation sites with alcohol-based preparations; 4. Antibiotic prophylaxis best practice. See separate materials. 5. Hand hygiene by healthcare staff and surgeons (WHO 5 Moments Standard)- see separate talk and Prof Widmer s talk 6. Improvements to recognition treatment of sepsis and post operative infection (see Sepsis)

15 Surgical site preparation: best practice Alcohol-based iodine or chlorhexidine preparations reduce surgical site infection by 36% compared to aqueous povidone. Safety issue: care required with alcohol solutions to avoid pooling under patient and to ensure drying prior to commencement of surgery (fire hazard with diathermy)

Safety issue: care required with alcohol solutions to avoid pooling under

16 Chlorhexidine/alcohol vs PVP iodine without alcohol for surgical site preparation: RCT SSA_Darouiche_NEJM_10 Chlorhexidine/alcohol PVP iodine Darouiche RO et al. N Engl J Med 2010;362:18-26

18 Meta-analysis of 7 studies:chlorhexidine vs iodine, for preoperative skin antisepsis with SSI as the outcome Lee I. Infect Control Hosp Epidemiol 2010; 31(12): December issue Andreas F. Widmer, MD,MS WHO - SSI

19 Infection prevention in surgery: priorities 1. WHO Safe surgery Saves Lives (World Alliance for Patient Safety); Safer Surgery Checklist 2. Surgical site infection surveillance- you can only improve what you measure! See separate materials. 3. Effective disinfection of surgical operation sites with alcohol-based preparations; 4. Antibiotic prophylaxis best practice. See separate materials. 5. Hand hygiene by healthcare staff and surgeons (WHO 5 Moments Standard)- see separate talk and Prof Widmer s talk 6. Improvements to recognition treatment of sepsis and post operative infection (see Sepsis)

22 Key references: surgical antimicrobial prophylaxis A Widmer WHO Webinar 2010 J Ferguson separate presentation Scottish SIGN evidence-based review 2008 Australian Guidelines: chapter on prophylaxis

23 Infection prevention in surgery: priorities 1. WHO Safe surgery Saves Lives (World Alliance for Patient Safety); Safer Surgery Checklist 2. Surgical site infection surveillance- you can only improve what you measure! See separate materials. 3. Effective disinfection of surgical operation sites with alcohol-based preparations; 4. Antibiotic prophylaxis best practice. See separate materials. 5. Hand hygiene by healthcare staff and surgeons (WHO 5 Moments Standard)- see separate talk and Prof Widmer s talk 6. Improvements to recognition treatment of sepsis and post operative infection (see Sepsis)

24 Hand disinfection by healthcare staff is the cornerstone of asepsis and saves lives even! See other presentation (WHO 5 Moments for Hand hygiene)

25 Questions- surgical services 1. Can the WHO Safe Surgery Checklist be implemented? 2. Are you/can you conduct reliable surgical site infection surveillance? 3. Can the WHO 5 Moments of Hand Hygiene program be implemented? 4. What are the demonstrated microbial causes of surgical wound infection at your hospital? 5. What antibiotics are used for surgical prophylaxis? 6. Is there a surgical prophylaxis guideline? 7. How long is prophylaxis given for? 8. What antiseptic method is used to prepare surgical incision site?

26 Key reference Provides list of evidence-based preop, operative and postoperative practices that are recommended for prevention of SSI A central document to assist surgical wound infection outbreak investigation and to enable proper design of surgical practices/processes

27 Excerpts The entire document is essential reading for all surgeons!

28 WHO Support Register on the WHO website as a participating hospital Implement the Surgical Safety Checklist in your hospital WHO Guidelines for Safe Surgery Additional resources available online at Also see A Widmer 2010 WHO Webinar presentation on Prevention of SSI

Errors in the Operating Room. Patrick E. Voight RN BSN MSA CNOR President Association of perioperative Registered Nurses (AORN)

Errors in the Operating Room. Patrick E. Voight RN BSN MSA CNOR President Association of perioperative Registered Nurses (AORN) Errors in the Operating Room Patrick E. Voight RN BSN MSA CNOR President Association of perioperative Registered Nurses (AORN) What What We All We Strive All Strive For: For: Patient Patient Safety Safety