Preventive Strategies for Surgical Site Infections外科手术部位感染的预防策略.ppt

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2018-06-05 发布于浙江
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Preventive Strategies for Surgical Site Infections外科手术部位感染的预防策略.ppt

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Preventive Strategies for Surgical Site Infections外科手术部位感染的预防策略

Controversies in Prevention of Surgical Site Infections Philip S. Barie, MD, MBA, FCCM, FACS Professor of Surgery and Public Health Weill Cornell Medical College New York, NY, USA Objectives To discuss the incidence of surgical site infections (SSI) following elective colorectal surgery. To review strategies to limit SSIs To review current national initiativesand standards of care for the prevention of SSIs Factors That Increase Risk of Infections After Colorectal Surgery Rectal resection vs intraperitoneal colon resection Operations lasting ≥3.5 hours Impaired host defenses Age 60 years Hypoalbuminemia Poor preoperative bowel preparation Bacterial contamination of surgical incision Corticosteroid therapy Malignant disease Defining Surgical Site Infections Defining Surgical Site Infections (cont.) Defining Surgical Site Infections (cont) Surgical Wound Classification Class 1 – Clean Uninfected operative wound, no inflammation Class II – Clean-Contaminated Alimentary tract (and others), under controlled conditions without unusual contamination Class III – Contaminated Major breaks in sterile technique, eg, gross spillage from the gastrointestinal tract Incisions encountering acute inflammation Class IV – Dirty-Infected Old traumatic wounds with dead tissue, infection, perforated viscera Major Pathogens in SSI Strategies to Limit SSIs History of Antibiotic Prophylaxis in Colorectal Surgery 1961: Animal studies by Burke demonstrated the importance of timing in preventing dermal or incisional infection.1 1969: Landmark study by Polk and Lopez-Mayor demonstrated a significant reduction of wound and intraabdominal sepsis among patients treated with antimicrobial prophylaxis.2 1970s: Key Veterans’ Affairs trials showed benefit of antibiotic prophylaxis over placebo in elective CRS 9% wound infection rate in antibiotic-treated patients vs 35% in placebo group3 Infection in 0 of 69 patients receiving neomycin-erythromycin base vs 3 of 16 patients receiving mechanical