Surgical Infection Prevention_ Focus On The OR.pptVIP

Surgical Infection Prevention:Focus On The ORMontrose Memorial Hospital D. Patrick Maher, MD, FACS Colorado Foundation For Medical Care April 8, 2005 Objectives Understand scope of problem Pathogenesis of Surgical Site Infections (SSIs) Determinants of Infection Classification and Risk of SSI Diagnosis of SSI Prevention of SSI Economics of SSI What is the collaborative? A joint effort under the direction of the Center for Medicare and Medicaid Services and the Centers for Disease Control and Prevention; developed by the Institute of Healthcare Improvement, Qualis Health, and a panel of clinical experts. Surgical Site Infections 2 - 5% of 40M operations are complicated by SSIs/yr (800,000-2,000,000) 14 - 16% of all nosocomial infections among hospitalized patients SSIs 2nd most frequent nosocomial infection 2 - 5% of clean extra-abdominal operations ~20% of patients having abdominal procedures Surgical Patients Surgical Site Infections Most common nosocomial infection 38% of all infections 77% of deaths related to infection 93% were serious infections of organs or deep spaces 1999 study: 255 infected patients ~ $2,000,000 Greater for deep space and organ SSI’s US national costs: $1 – 10 B/yr Surgical Site Infections ~40 – 60% are PREVENTABLE! 25 – 50% Overuse Under use Improper timing Misuse 16% of Clostridium difficile infections are from prophylaxis alone. Surgical Site Infections Case Control* Study of 255 Pairs Infected Uninfected Mortality 7.8% 3.5% ICU Adm. 29% 18% L.O.S. 11d 6d Median direct cost $7531 $3844 Readmission 41% 7% *matched for procedures, NNIS risk index, age Kirkland, Infection Control Hospital Epidemiology 1999; 20: 725 Pathogenesis of SSI All surgical wounds are contaminated with bacteria A minority of wounds develop clinical infection Innate host defenses efficient at eliminating wound conta