Infection Prevention and Control Committee (IPCC)

Hand Hygiene ProgramHealthcare Associated Infections (HCAI)Surgical Site Infection (SSI) Surveillance

AntibiogramAntimicrobial Stewardship Program (ASP)

Quality Management Department MeetingJuly 18, 2012

1200H – 1400H

Participants (Total) = 3,039

Participants (In-house) = 1,666

IntroductionIntroduction

SSIs are the third most frequently reported healthcare associated infection accounting for 14%-16% of all health care associated infection among hospitalized patients.

1. Exploratory Laparotomy

2. Total Abdominal Hysterectomy Bilateral Salphingo Oophorectomy (TAHBSO)

3. Coronary Artery Bypass Graft (CABG)

Operative Procedures Operative Procedures to be monitored:to be monitored:

SSI Surveillance MethodSSI Surveillance Method1. The Infection Prevention and Control Nurse (IPCN)

will inform the attending physician / surgeon that the patient will be included in the surveillance of SSI.

2. Once the patient is admitted, the IPCN will join the surgeon or the patient care staff nurse (PCSN) on his / her rounds pre-operatively and inform the patient that he / she is included in the post-operative follow up.

3. Post-operatively, the IPCN will accomplish the SSI Prevention Checklist for Healthcare Workers.

4. Post operatively, the IPCN will visit the patient at the time the wound is opened by the attending physician and observe the wound for any signs of infection.

5. On the second and fourth week post-operatively, a call will be made by a member of the surveillance team and a telephone interview will be conducted.

6. If the patient did not report any of the sign or symptom of SSI post-operatively, the case will be evaluated as having “no SSI”.

7. If the patient reported signs and symptoms of SSI post-operatively, the case will be investigated. The SSI Surveillance Form (based from Centers for Disease Control and Prevention) will be accomplished.

8. Once the surveillance form has been accomplished, the IPCN will present it to the Infectious Disease Consultant for confirmation if the signs and symptoms of the patient satisfied the criteria for a confirmed SSI.

9. If the case satisfied the criteria for a confirmed SSI, the IPCN will inform the attending physician / surgeon.

10. SSI rates will be presented to department meetings. Anonymous feedback will be given to the attending physician whose patient/s developed SSI.

11. Before implementation, IPCC will inform all concerned departments.

References:

• Whitby et al. (2002). “Post Discharge Surveillance: Can Patients Reliably Diagnose Surgical Wound Infections?” Journal of Hospital Infection

• Mangram et al. (1999). “Guideline for Prevention of Surgical Site Infection” Infection Control and Hospital Epidemiology

MRSA Carriage Protocol

Laboratory test - Swab (nasopharyngeal , axillae, inguinal)

Treatment initially with:

Clindamycin 300mg Q6H x 7 days

Ciprofloxacin 500mg BID x 7 days

Mupirocin ointment over nares TID x 7 days

4% CHG bath OD x 7 days

If swab Negative – Back to duty

If swab Positive – Treatment with:

Doxycycline 100mg BID x 7 days

Rifampicin 300mg BID x 7 days

Re-swab - Back to duty when Negative