Infection Prevention and Control Committee (IPCC) Hand Hygiene Program Healthcare Associated Infections (HCAI) Surgical Site Infection (SSI) Surveillance Antibiogram Antimicrobial Stewardship Program (ASP) Quality Management Department Meeting July 18, H – 1400H

Participants (Total) = 3,039 Participants (In-house) = 1,666

Introduction 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 to be monitored:

SSI Surveillance Method 1.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

Escherichia coli 14 (n=322) 11 (n=310) 9 (n=344) 12 (n=270) 6 (n=225) 9 (n=242) Klebsiella pneumoniae 20 (n=148) 7 (n=191) 16 (n=103) 8 (n=87) 4 (n=122) 5 (n=122)

1.MRSA % 54 (n=68) 50 (n=94) 47 (n=88) 30 (n=60) 43 (n=56) 20 (56)

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