Nosocomial Infection and Surgical Site Infection

Nosocomial Infection (Hospital Acquired Conditions) and Surgical Site InfectionJocliedian G LDeny BudimanAchmad PrihadiantoHendrikus MB Bolly

What are Hospital Acquired Infections (HAIs)Blood Stream InfectionsVentilator Associated Pneumonia (VAP)Surgical Site Infections (SSI)Urinary Catheter Associated Infection (CAUTI)Multi-drug Resistant Organism (MRO)Blood Stream Infections (BSI)Blood Stream Infections occur after the insertion of an IV catheter either peripherally or centrally within 48 hours of insertion up to 48 hours after removal.A BSI requires 2 positive blood cultures, with pathogens not related to an other infection.PSMH as adopted the Central Line Insertion Bundle to help prevent Central Line Blood Stream Infections.

Ventilator Associated Pneumonia (VAP)Ventilator Associated Pneumonia is defined as a lung infection occurring after a patient is placed on the ventilator. The diagnosis is confirmed by analysis of the infection by the Infection Control DepartmentSurgical Site Infections (SSI)Surgical site infections are defined as infections that occur within 30 days of surgery, unless an implant is inserted during the procedure then the time increases to 3 months.All reported SSIs are analyzed for preventability and reports are provided to the Infection Control Committee, Department of Surgery, Clinical Operations, Quality Board, CMS Core measures, and CDC.Catheter Associated Urinary Tract Infections (CAUTI)Urinary Catheter Associated Infections are defined as an infection occurring 48 hours after insertion of a urinary catheter, signs and symptoms of infection (fever, pain, frequency, urgency, increased white count, etc.) and a positive urine culture of 100,000CFU/ml with no more than 2 species of bacteria.Multidrug Resistant Organism (MRO)Multidrug resistant organisms of concern at PSMH are Methicillin Resistant Staphylococcus Aureus (MRSA), Vancomycin Resistant Entercoccus (VRE) and Clostridium Difficile (C. Dif)MROs are bacteria that have become resistant to many of the antibiotics used to treat infections caused by them.SSI Definition A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. Most patients who have surgery do not develop an infection. However, infections develop in about 1 to 3 out of every 100 patients who have surgery. Some of the common symptoms of a surgical site infection are: Redness and pain around the area where you had surgery Drainage of cloudy fluid from your surgical wound Fever

Types of SSISuperficial Incisional SSIInfection occurs within 30 days after the operation and involves only skin or subcutaneous tissue of the incisionMangram AJ et al. Infect Control Hosp Epidemiol. 1999;20:250-278.

Subcutaneous tissueSkinSuperficial incisional SSI9The first type of surgical site infection is the superficial incisional surgical infection which occurs within 30 days post-op and involves only the skin or subcutaneous tissue.Deep Incisional SSIInfection occurs within 30 days after the operation if no implant is left in place or within 1 year if implant is in place and the infection appears to be related to the operation and the infection involves the deep soft tissue (e.g., fascia and muscle layers)

Deep soft tissue (fascia & muscle)Deep incisional SSISuperficial incisional SSIMangram AJ et al. Infect Control Hosp Epidemiol. 1999;20:250-278.10A more serious SSI is a deep incisional surgical infection, which extends past the superficial layer. The infection occurs within 30 days post-op only if no implant is left in place or within 1 year if implant is in place and the infection appears to be related to the operation and the infection involves the deep soft tissue, which include the fascia and muscle layers.Organ/Space SSIInfection occurs within 30 days after the operation if no implant is left in place or within 1 year if implant is in place and the infection appears to be related to the operation and the infection involves any part of the anatomy, other than the incision, which was opened or manipulated during the operationDeep incisional SSISuperficial incisional SSI

Organ/space SSIOrgan/spaceMangram AJ et al. Infect Control Hosp Epidemiol. 1999;20:250-278.11The most extensive of these surgical infections involves the organs and the space surrounding the organs. These infections can occur within 30 days post-op if no implant is left in place or within 1 year if an implant is in place and the infection appears to be related to the operation and the infection involves any part of the anatomy, other than the incision, which was opened or manipulated during the operation.SSI Risk FactorsOperation FactorsDuration of surgical scrubMaintain body tempSkin antisepsisPreoperative shavingDuration of operationAntimicrobial prophylaxisOperating room ventilationInadequate sterilization of instrumentsMangram AJ et al. Infect Control Hosp Epidemiol. 1999;20:250-278.Foreign material at surgical siteSurgical drainsSurgical techniquePoor hemostasisFailure to obliterate dead space Tissue trauma12Both operation factors and patient characteristics may influence the risk of surgical site infection. Depending on the conditions of the operation a patient can be at an even greater risk of infection. These factors can include duration of surgical scrub, maintenance of body temperature, the use of skin antisepsis, preoperative shaving, duration of the operation, antimicrobial prophylaxis, ventilation of the operating room, inadequate sterilization of instruments, the presence of foreign material at the surgical site, surgical drains, and surgical technique. Poor surgical technique includes poor hemostasis, failure to obliterate dead space, and tissue trauma.

SSI Risk FactorsPatient CharacteristicsAgeDiabetesHbA1C and SSIGlucose > 200 mg/dL postoperative period (