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Reducing HCAIs
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TOPIC: Reducing SSI's new ideas or no idea?

Reducing SSI's new ideas or no idea? 2 months ago #1

Is it simply just a case of keep doing the same old things but better?
Do we have exciting ideas we need to share?

Re: Reducing SSI's new ideas or no idea? 1 month, 3 weeks ago #2

My thoughts on reducing HCAIs are that we need to keep up total vigilance and not let standards slip under pressures (such as winter bed pressures). It is really important to keep up the impetus.

Re: Reducing SSI's new ideas or no idea? 1 month, 3 weeks ago #3

1 surgical site infection is 1 too many. We should consider these episodes never events unless all the recognised evidence based interventions are in place, irrespective of how costly they may be to implement.

- HEPA filtration to remove microbes from the operating theatre atmosphere has been shown to be significantly more effective than laminar flow - why is this not present in all operating theatres?

- All patients should be bathing pre-operatively with chlorhexidine

- Glycaemic control should be monitored in all patients, not just diabetics

- 100% compliance with appropriate timing of administration of antibiotics

- chlorhexidine / alcohol skin preparation is clearly superior to povidone-iodine

Re: Reducing SSI's new ideas or no idea? 1 month, 2 weeks ago #4

It takes total engagement to succeed in reducing SSIs. The level of awareness needs to be heightened and sustained by all stakeholders in order to avoid and reduce SSIs. One way is by empowering those who feel that the surgeon has the final say. Pressures on cost must also be emphasised when SSIs develop and the simple message should be that it can be avoided.

An example is evidence based practice where Chlorhexidine skin prep should be the standard solution, whoever chooses not to use it must be encouraged to change practice.

Re: Reducing SSI's new ideas or no idea? 1 month, 1 week ago #5

I think there are still things that we need to keep on doing the same thing especially in theatre such as maintaining the aseptic technique to reduce surgical infection.However new ideas come up basing on recent research which we need to integrate in our practice, we have different skin prep that has been tested to reduce the occurence of infection...eg. chloroprep.Different wound sealant is also available in the market which the surgeon is happy to use which accdg to research a good wound closure increases the wound to heal without the occurence of any signs of infection...eg..prineo, dermabond.

Re: Reducing SSI's new ideas or no idea? 1 month ago #6

The problem that we face these days is that Evidence Based Medicine dictates that we need a full list of Randomised Controlled Trials to prove an intervention has a high enough benefit to cost ratio.

This is complicated further by the fact that SSIs are multicausal and it is virtually impossible to "prove" that each intervention alone reduces the number of SSIs, from the antiseptic washing that is carried out by the patient at home prior to reaching the hospital, via each antiseptic practice/medical device that is used in the OR, right through to the cleanliness of post-dressing change areas at home once the patient has been discharged.

What we need is more awareness and education on each step within the bundle approach, and how each step would reduce the risk within each cause so that individual NHS trusts do not need to worry about their number of superficial SSIs that get lost into Primary Care (see recent work by Judith Tanner et al.)because they can be satisfied that they have done their utmost to reduce the number of infections as best they can.

Re: Reducing SSI's new ideas or no idea? 1 month ago #7

I totally agree with Anthony Parsons' comment. We must remember that those days surgeons' were meant to make the final say-is now history!
These days-changes within our healthcare means that patients have the last say in their care. We have patient centered care therefore what we should be doing,is to encourage by providing ideas to patient on how to implement best practice guidelines.

Home care hygiene should emphasis more on personal hygiene care and we have work to do on that yet.

Re: Reducing SSI's new ideas or no idea? 1 month ago #8

At Heart of England NHS Foundation Trust we have recently carried out an SSI surveillance project which demonstrated a significant improvement in the rate of surgical site infections when 2% chlorhexidine in 70% alcohol was used for pre-operative skin preparation as oppose to aqueous iodine. We are also implementing use of octenisan for routine washing of all in patients including pre-operative patients.

Re: Reducing SSI's new ideas or no idea? 1 month ago #9

Hi Gill
Congratulations on your SSI reduction strategy, i hpe you will have a little party amongst yourselves, or a celebratory email to the rest of the site :-)

Being a strng advocate of antiseptic body washing myself, I am interested to know why you chose octenisan for routine washing rather than a chorhexidine product when you have achieved a good rate of SSI reduction with a chlorhexidine prep product.
I read a paper recently on the cumulative nature of chlorhexidine providing more reduction than the sum of the individual wash and prep parts when used in combination with each other....?
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