Infectious Diseases II
| (e) | Perineum: Aerobic gram-negative and mixed anaerobic organisms |
|---|---|
| (f) | Respiratory: Aerobic gram-positive and gram-negative organisms |
Risk factors for SSIs:
Patient-related factors
Nonmodifiable
| (a) | Advanced age |
|---|---|
| (b) | History of skin and soft tissue infection |
| (c) | Recent radiation |
ii.
ii. Modifiable
| (a) | Anticoagulation |
|---|---|
| (b) | Current tobacco use |
| (c) | Diabetes |
| (d) | Hypoalbuminemia (preoperative albumin less than 3.5 mg/dL) |
| (e) | Immunosuppression |
| (f) | Obesity |
| (g) | Preoperative infections |
| (h) | S aureus nasal colonization |
Procedure-related factors
Inadequate ventilation/airborne contamination
ii.
Blood transfusions
iii.
Decreased tissue oxygenation
iv.
Presence of foreign material
Longer operative time
vi.
Perioperative hypothermia
vii.
Postoperative hyperglycemia
viii.
Poor wound care
ix.
Wound contamination from patient and/or operating room personnel
Inadequate skin preparation
Prevention strategies: Pharmacy specific
Using evidence-based guidelines can prevent up to 60% of postoperative wound infections. Wound
infections after elective operations are considered preventable and are reportable health care–
associated infections.
Many organizations and agencies promote prevention and have guidance on the prevention of SSIs,
including the CDC, SCIP, The Joint Commission (TJC), Centers for Medicare & Medicaid Services
(CMS), Society of Healthcare Epidemiology of America (SHEA), WHO, American College of
Surgeons (ACS), and Surgical Infection Society (SIS).
CMS no longer provides reimbursement to providers for the treatment of SSIs after cardiac,
bariatric, orthopedic surgical procedures
Preoperative
Control serum blood glucose in patients with diabetes (goal blood glucose 110-150 mg/dL).
ii.
Administer prophylactic antibiotics within 1 hour before surgery (vancomycin and
fluoroquinolones should be administered within 2 hours before surgery because of prolonged
infusion times).
iii.
Select the appropriate prophylaxis – See Table 1.
| (a) | 10%–15% of the U.S. population report an allergy to penicillin antibiotics and 1%–2% to |
|---|
cephalosporin antibiotics; these allergy labels often result in avoidance of cefazolin and
use of alternative antibiotics (e.g., vancomycin, clindamycin).