Excerpt

Infections that occur in the wound created by an invasive surgical procedure are generally referred to as surgical site infections (SSIs). SSIs are one of the most important causes of healthcare-associated infections (HCAIs). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. SSIs accounted for 14% of these infections and nearly 5% of patients who had undergone a surgical procedure were found to have developed an SSI. However, prevalence studies tend to underestimate SSI because many of these infections occur after the patient has been discharged from hospital.

SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related, at least in part, to SSI. However, it is important to recognise that SSIs can range from a relatively trivial wound discharge with no other complications to a life-threatening condition. Other clinical outcomes of SSIs include poor scars that are cosmetically unacceptable, such as those that are spreading, hypertrophic or keloid, persistent pain and itching, restriction of movement, particularly when over joints, and a significant impact on emotional wellbeing.

SSI can double the length of time a patient stays in hospital and thereby increase the costs of health care. Additional costs attributable to SSI of between £814 and £6626 have been reported depending on the type of surgery and the severity of the infection. The main additional costs are related to re-operation, extra nursing care and interventions, and drug treatment costs. The indirect costs, due to loss of productivity, patient dissatisfaction and litigation, and reduced quality of life, have been studied less extensively.

Contents

• Guideline Development Group membership and acknowledgements
• Abbreviations
• Glossary of terms
• 1. Introduction
  • 1.1. Surgical site infection
  • 1.2. Aim of the guideline
  • 1.3. Areas outside of the remit of the guideline
  • 1.4. For whom is the guideline intended?
  • 1.5. Who has developed the guideline?
  • 1.6. Other relevant documents
  • 1.7. Guideline methodology
  • 1.8. Schedule for updating the guideline
• 2. Summary of recommendations
  • 2.1. Key priorities for implementation (key recommendations)
  • 2.2. Summary of recommendations
  • 2.3. Key priorities for research
  • 2.4. Summary of research recommendations
• 3. Definitions, surveillance and risk factors
  • 3.1. Defining surgical site infection
  • 3.2. Surveillance for surgical site infection
  • 3.3. Risk factors
• 4. Information for patients and carers
  • 4.1. Information for patients and carers
• 5. Preoperative phase
  • 5.1. Preoperative showering
  • 5.2. Hair removal
  • 5.3. Patient theatre wear
  • 5.4. Staff theatre wear
  • 5.5. Staff leaving the operating area
  • 5.6. Nasal decontamination
  • 5.7. Mechanical bowel preparation
  • 5.8. Hand decontamination (general)
  • 5.9. Hand jewellery, artificial nails and nail polish
  • 5.10. Antibiotic prophylaxis
• 6. Intraoperative phase
  • 6.1. Hand decontamination
  • 6.2. Incise drapes
  • 6.3. Use of sterile gowns
  • 6.4. Disposable or reusable drapes and gowns
  • 6.5. Gloves
  • 6.6. Antiseptic skin preparation
  • 6.7. Diathermy
  • 6.8. Maintaining patient homeostasis
  • 6.9. Wound irrigation and intracavity lavage
  • 6.10. Antiseptic and antimicrobial agents before wound closure
  • 6.11. Closure methods
  • 6.12. Wound dressings
• 7. Postoperative phase
  • 7.1. Changing dressings
  • 7.2. Postoperative cleansing
  • 7.3. Topical antimicrobial agents for wound healing by primary intention
  • 7.4. Dressings for wound healing by secondary intention
  • 7.5. Antibiotic treatment of surgical site infection and treatment failure
  • 7.6. Debridement
  • 7.7. Specialist wound care services
• Appendix A. Declarations of interest
• Appendix B. Clinical questions
• Appendix C. Wound dressings for surgical site infection prevention
• Appendix D. Cost-effectiveness of hair removal
• Appendix E. Cost-effectiveness of mupirocin nasal ointment to prevent surgical site infection caused by Staphylococcus aureus
• Appendix F. Cost-effectiveness of closure methods
• Appendix G. Cost analysis of wound dressings
• Appendix H. General principles for hand hygiene (epic2)
• Appendix I. Postoperative cleansing of the wound
• References
• Search strategies
• Excluded studies
• Evidence tables

While every effort has been made to ensure the accuracy of the information contained within this publication, the publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check current indications and accuracy by consulting other pharmaceutical literature and following the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which they are practising.