1. Risk factors for surgical site Infections
دکتر کورش صفوی پور
متخصص بیماریهای عفونی
زمستان 1394

2. SSIS
Surgical site infections(SSIS) are a common and unwanted outcome from most types of surgical procedures (84% occurred after hospital discharge)

3. SSIS
SSIS
Are
preventable

4. SSIS
The development of an SSI depends on Patient-related Procedure-related Pathogen-related Application of evidence-based prevention methods

5. SSIS
Causative organisms of SSI are predominantly the flora present at the incision site

6. SSIS عوامل شایع به ترتیب: S.aureus Coagulase-negative staphylococci
E.coli
Enterobacter
Klebsiella
Seratia
candida

7. SSIS

8. SSIS عوامل مستعد کننده Patient factors Procedural factors
Proceduralist factors

9. SSIS

10. SSIS

11. SSIS

12. Maneuvers to diminish inoculation of bacteria into wound
SSIS
Maneuvers to diminish inoculation of bacteria into wound

13. SSIS

14. SSIS

15. Maneuvers to improve host containment of contaminating bacteria
SSIS
Maneuvers to improve host containment of contaminating bacteria

16. SSIS

17. SSIS

18. SSIS

19. SSIS

20. Surgical antimicrobial prophylaxis
SSIS
Surgical antimicrobial prophylaxis
Key principles
Maintain tissue concentration of drug above minimal inhibitory concentration (MIC) of common flora

21. SSIS

22. Surgical antimicrobial prophylaxis
SSIS
Surgical antimicrobial prophylaxis
Key principles
“ right drug ”

23. SSIS “ right drug ” Provide Thus target flora at surgical site
penetrate surgical incision site
and
achieve minimal adverse events

24. SSIS

25. SSIS

26. SSIS

27. SSIS

28. SSIS

29. SSIS CDC recommendations Antibiotic prophylaxis be used for
all clean-contaminated procedures
Certain clean procedures
intravascular prosthetic material
Prosthetic joint
Incisional or organ/space SSI would pose catastrophic risk

30. Surgical antimicrobial prophylaxis
SSIS
Surgical antimicrobial prophylaxis
Key principles
“ right dose”
at the
“ right time”

31. SSIS

32. SSIS Antibiotic prophylaxis as delivery of the antibiotic
within 60 minutes before incision
( for vancomycin & fluoroquinolones 120 minutes )

33. SSIS

34. SSIS

35. SSIS

36. SSIS

37. Surgical antimicrobial prophylaxis
SSIS
Surgical antimicrobial prophylaxis
Key principles
“ right duration”

38. SSIS
Provide “ right duration” of drug Stop once incision closed or by 24 hours at the latest

39. SSIS
Most guidelines for surgical prophylaxis recommend discontinuation of prophylactic antibiotics within 24 hours For cardiac surgery ,some groups recommend continuing prophylaxis for 48 hours

40. Right drug At the Right dose Given at the Right time
SSIS
Right drug At the Right dose Given at the Right time

41. Newer methods for delivery of antimicrobial prophylaxis
SSIS
Brachytherapy
Newer methods for delivery of antimicrobial prophylaxis
such as
antimicrobial washes,cement,sutures,and other compounds ,have been increasingly used for the prevention of SSIs

42. SSIS
Antibiotic – impregnated cement Implantable gentamicin-collagen sponges