Surgical Site Infection

What’s what in the WHO guidelines

Disclosures

Nothing to disclose

Except you may be have heard me talk about SSIs before…

2%

2%

2%

2%

3%

3%

4%

4%

4%

5%

5%

5%

6%

7%

9%

10%

18%

19%

Cerebrovascular Accident

Cardiac Pulmonary Resuscitation

Renal Insufficiency

Acute Renal Failure

Pulmonary Embolism

Deep Vein Thrombosis

Wound Disruption

Septic Shock

Myocardial Infarction

Deep SSI

Unplanned Intubation

Ventilators 48h

Organ SSI

Sepsis

Post-op Death in 30 days

Pneumonia

Superficial SSI

Urinary Tract Infection

Type of Post-Op Outcomes

Any SSI: 29% Any Sepsis: 10% Respiratory: 10% DVT/PE: 6% Cardiac: 6% Renal: 4%

Who gets an SSI?

Cardiac Surgery

General Surgery

Vascular Surgery

Orthopedic Surgery

1.2%

1.5%

1.5%

1.7%

2.4%

2.8%

3.2%

4.6%

4.9%

6.6%

Urology

Orthopedics

Neurosurgery

Otolaryngology (ENT)

Gynecology

Thoracic

Plastics

Vascular

General Surgery

Cardiac

Surgical Site Infections by Specialty

226 of 3,440

2,616 of 52,953

234 of 5,121

364 of 11,301

61 of 2,190

426 of 17,538

130 of 7,663

86 of 5,787

730 of 49,157

241 of 20,820

How is BC doing?

What is BC doing?

WHO Guidelines

Adult Surgical Patients

Some Guidelines are for Special Populations

Pre/Intra/Post Operative

Things we already do…

Pre-Operative

• Bathing

• Hair Removal

• Surgical Site Prep

• Antibiotic Prophylaxis

But what about these?

• Decolonization

• Mechanical bowel prep & abx

• Nutritional support

Things we already do…

Intra-Op

• Normothermia

• Glucose control

• Normovolemia

But what about these?

• Wound protector

• Negative pressure wound therapy

• Anti-microbial sutures

Things we already do…

Post-Op

• Discontinue prophylactic antibiotics

• Remove drains when clinically indicated

So how do we make this happen?

Surgical Site Infections A Surgeon’s Perspective

Dr. David E. Konkin, MD, FRCSC, FACS

General Surgeon Royal Columbian Hospital/Eagle Ridge Hospital

Nothing to disclose

Except that I do get SSI’s……

Overview

! SSI’s at RCH/FHA

! WHO Guidelines – Surgeon’s perspective

! Key principles

RCH

!  Trauma, Cardiac, Neuro, High-risk Maternity/Neonatal ICU

!  General Surgery, Trauma, Colorectal, Hepatobiliary, Surgical Oncology

!  Tertiary Centre for FHA

NSQIP (National Surgical Quality Improvement Program)

!  Second hospital in Canada to join NSQIP (1st was Surrey Memorial Hospital)

!  Joined 2006

!  ERAS since 2007 (before it was called ERAS)

RCH Story

They live….

Exemplary Status

! Evidence-based

! Clear

WHO Guidelines

!  World Assessment

!  Stress surveillance (most do not have NSQIP)

!  Basic cleaning

!  Pre/Intra/Postop

ERAS

SSI reduction strategies

Highlights

Wound protector

Negative pressure wound therapy

Intense glucose control

Mechanical bowel prep with Abx

Perioperative 02 supplementation

Enhanced nutritional formulas

Antimicrobial-coated sutures

TEAMWORK EDUCATION DATA

TEAMWORK

EDUCATION

DATA

0

0.5

1

1.5

2

2.5

3

3.5

4

Odd

s Ra

tios

Monthly Period

Eagle Ridge Hospital All Cases Surgical Site Infections Risk Adjusted Projected Odds Ratio (OR) Report,

December 1, 2014 - November 30, 2016

SSI ORs

Trendline for ORs

Target OR = 1 or less

Drilldown

Quality Indicators

Quality Indicators

TEAMWORK EDUCATION DATA

SO WHAT DO WE DO NOW? What’s what in the WHO guidelines

Start with the basics

Measure

And then move on to something else

Questions?????