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DOI: 10.1086/598189 [Context Link], Newhouse R., Dearholt S., Poe S., Pugh L., White K. (2007). Most SSIs are SSI-1, primarily decreased with the checklist. Kunkle CM, Marchan J, Safadi S, Whitman S, Chmait RH. With the high volume of patients receiving arthroplasties, infection control practices need to be taken seriously. Cochrane Database Syst Rev. Across the globe, Staphylococcus aureus has been one of the leading causes of infections for several decades. Steps 17 and 18 conclude The Johns Hopkins process. A PICOT format, a process to structure clinical questions to facilitate a useful search to find relevant answers, was used for Step 1 (identifying an EBP question) (Melnyk & Fineout-Overholt, 2011). 2008;199(3):301.e1e6. Kurtz et al. American College of Obstetricians and Gynecologists. Effects of maternal obesity on tissue concentrations of prophylactic cefazolin during cesarean delivery. Pevzner L, Swank M, Krepel C, et al. Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery. The evidence is then summarized on the basis of strength and recommendations are made for change. The National Healthcare Safety Network (NHSN) reported an overall SSIs rate of 1.9% from 2006 to 2008 with 16,147 SSIs in 849,659 operations [ 5 ]. In African countries, infection is the most frequent complication in surgery and published guidelines for the prevention of surgical site infection in 2017. pii:S16841182(13)001503.20. The effect of washing with chlorhexidine soap on wound infection rate in general surgery: a controlled clinical study. World J Gastroenterol. Other factors that can contribute to a patient's risk for infection, which institutions have very little control over, is a patient's home environment and patient compliance with treatment regimens, dressing changes done in the home and the patient's hand hygiene practices. These team members were selected on the basis of their involvement with the Joint Center and infection prevention. Reduction of Cesarean Section Surgical Site Infections (SSI): Progression and Implementation of Evidence Based Practice Patricia Dumonceaux CentraCare Health, dumonceauxp@centracare.com Melissa Erickson CentraCare Health, ericksonme@centracare.com Kim Schuster CentraCare Health, schusterk@centracare.com Elizabeth Kiffmeyer (2012) concluded the use of a screen and treat process before total joint arthroplasty is a simple, safe, and cost-effective intervention that can reduce the risk of SSI. Surgical site infections (SSIs) are the most frequent HAI in low- and middle-income countries (LMICs), and can affect up to one-third of surgical patients (2). Reduction of surgical site infections in low transverse cesarean section at a university hospital. Surgical site infection prevention initiative: Patient attitude and compliance. The CNS and the infection preventionist agreed to disseminate the findings, attend nursing and infection control events with poster presentations, publish the results, and communicate the findings within the institution. Methicillin-resistant Staphylococcus aureus has the ability to form a biofilm on the implant creating an ideal environment for bacterial survival, multiplication, and antibiotic resistance (Goyal, Aggarwal, & Parvizi, 2012). In this review, we offer 10 evidence-based strategies to prevent surgical site infection (SSI) after cesarean delivery. Ann Chir Gynaecol. Surgical site infections are associated with signicant patient morbidity and mor- gluconate (CHG). Therefore, appropriate screening and treatment to decolonize patients with methicillin-susceptible Staphylococcus aureus (MSSA) or MRSA in the nares can potentially eliminate the risk of SSI, prevent complications, and avoid unwanted costs. CDC Definitions of Surgical Site Infections SSI occurs within 30 days after the procedure (or within 1 year if an implant) has at least one of the following: purulent drainage from the incision organisms isolated from an aseptic culture of the incisional fluid or tissue incision deliberately opened by the surgeon Although data are limited on the impact of perioperative glycemic control on postcesarean infection rates, the association has been well documented in the general surgery literature. 7 That estimate accounts for only those patients who survive. World J Gastroenterol. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. Maternal outcomes in pregnancies complicated by obesity. 1. The nurse's understanding of the EBPs will only help to hold each other and each department accountable for the new process. Infect Control Hosp Epidemiol. Upon further investigation, it was concluded that switching from molecular screening to a bacterial culture, there would be an approximate savings of $20 per patient. 1. [Context Link]. Sign in, July/August 2015, Volume 34 Number 4 , p 188 - 194. 1987;10(2):165172.10. Results of a retrospective cohort study of 995 patients undergoing general or vascular surgery demonstrated that postoperative hyperglycemia increased the risk of infection by 30% for every 40-point increase in serum glucose levels from normoglycemia (defined as <110 mg/dL) (odds ratio, 1.3; 95% confidence interval [CI], 1.031.64).5 Hyperglycemia causes abnormalities of leukocyte function, including impaired granulocyte adherence, impaired phagocytosis, delayed chemotaxis, and depressed bactericidal capacity. Obstet Gynecol. 1999;20(4):250278.8. Surgical site infection (SSI) continues to represent a significant portion of healthcare-associated infections because of their impact on morbidity, mortality, and cost of care. pii:S16841182(13)001503.20. The CNS felt compelled to reinforce to the nurses the importance of hand hygiene, sterile dressing changes, and appropriate timing of antibiotics (IHI, 2012). In 2015, under the value-based purchasing program, the Centers for Medicare & Medicaid Services will reduce payments for total knee and hip replacement readmissions placing an even greater finical strain on hospitals (Lee & Moorhead, 2014). J Int Med Res. Unauthorized use prohibited. Obstet Gynecol. Currently, all arthroplasty patients are admitted to a noninfectious surgical floor. Infection Control and Hospital Epidemiology, 33(2), 152-159. doi:10.1086/663704 [Context Link], De Lissovoy G., Fraeman K., Hutchins V., Murphy D., Song D., Vaughn B. Today there are many financial burdens on hospitals, and one of them includes readmissions. A step-by-step guide on how to use the CHG wash and nasal ointment was included. 10 practical, evidence-based recommendations for improving maternal outcomes of cesarean delivery, Nurse Practitioners / Physician Assistants. Saving You Time. 1 Maintain strict glycemic control in women with diabetes, Perioperative hyperglycemia is associated with an increased risk of postoperative infection in patients with diabetes. However, results of a recent meta-analysis of 5 randomized controlled trials demonstrated that antibiotic prophylaxis significantly reduced infectious morbidity (RR, 0.50; 95% CI, 0.330.78) when it was given 60 minutes before the skin incision, with no significant effect on neonatal outcome.13, 4 Give a higher dose of preoperative antibiotics in obese women, Given the increased volume of distribution and the increased risk of postcesarean infection in the obese population, a higher dose of preoperative antibiotic prophylaxis is recommended. During the first phase, a practice question is identified, an interdisciplinary team is formed, and a leader is identified. Use of this Web site is subject to the medical disclaimer. The team will continue to track SSI, determine why they occurred, and the changes that need to be made to prevent future occurrences. A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. Patient compliance is an important component in the success of preventing SSIs (Ramos et al., 2011). Webster J, Osborne S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Surgical site infection (SSI) is a serious complication after coronary artery bypass grafting (CABG). As an end result of the study, the screening and treatment program was associated with a 59% reduction in the rate of SSI in comparison to the control period. Obstet Gynecol. Webster J, Osborne S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. A study of more than 700 patients showed that preoperative showers with chlorhexidine reduced bacterial colony counts 9-fold, compared with only 1.3-fold for povidone-iodine.7 Whether this translates into a reduction in SSI remains controversial, in large part because of poor quality of the existing prospective trials, which used different agents, concentrations, and methods of skin preparation.8, Small clinical trials have found a benefit to chlorhexidine treatment the day before surgery.9,10 However, a recent meta-analysis of 16 randomized trials failed to show a significant reduction in the rate of SSI with chlorhexidine compared with soap, placebo, or no washing (relative risk [RR], 0.90; 95% CI, 0.771.05).11, 3 Administer intravenous antibiotic prophylaxis, All patients who undergo cesarean delivery should be given appropriate antibiotic prophylaxis within 60 minutes before the skin incision. During this meeting, the summary of evidence was presented, step 11 of the JHNEBP model, and the team discussed the appropriateness and practicability of implementing the recommendations. Data-driven guidance on multiple aspects of cesarean delivery, from preoperative glycemic control to strategies for obese patients. This article describes simple, affordable, evidence-based practices organizations can put into place to reduce such infections. American College of Obstetricians and Gynecologists. According to the Center for Disease Control (CDC, 2016), surgical site infections (SSI) are the most common healthcare-associated infection. Surgical Site Infections (SSI) At the Johns Hopkins Hospital, we perform SSI surveillance for coronary artery bypass graft (CABG), Cesarean section (C-section), craniotomy, laminectomy, hip replacement, knee replacement, adult spinal fusion, and pediatric spinal fusion procedures. The JHNEBP model is composed of three basic nursing concepts: practice, education, and research. Twenty-four MSSA-positive and three MRSA-positive patients were identified by the interdisciplinary team. Other surgical site infections are more serious and can involve tissues under the skin, organs, or implanted material. Institutional prescreening for detection and eradication of methicillin resistant Staphylococcus aureus in patients undergoing elective orthopaedic surgery. 2011;117(4):877882.16. In a hospital setting, S. aureus is the most common source of infection in inpatients and the second most prevalent source in outpatients (Naber, 2009). Surgical Site Infections In Forbes et al. Suture closure of subcutaneous fat and wound disruption after cesarean delivery: a meta-analysis. effect of surgical site infections Of all the HAIs in the United States, surgical site infections (SSIs) are the most common and costly, accounting for 20% of all HAIs, with an estimated annual national cost of $3 to $5 billion. Am J Infect Control. Kunkle CM, Marchan J, Safadi S, Whitman S, Chmait RH. A placebo-controlled trial of the effect of two preoperative baths or showers with chlorhexidine detergent on post-operative wound infection rates. An external search for evidence was completed of English language research published in 2006-2014 on orthopaedic surgical site infection prevention. By screening patients just prior to surgery, it can be concluded that decolonization was effective and the patient was compliant with using the CHG wash and nasal antibiotic, all of which may help in further reducing postoperative infections (Goyal et al., 2012). Pregnancy-related mortality in the United States, 20062010. Furthermore, as EBP continues to evolve, third party payers will begin to only provide reimbursement to those healthcare providers who are providing care that is evidence based. [Context Link], Kurtz S., Lau E., Schmier J., Ong K., Zhao K., Parvizi J. The results revealed both the screen and treat, Group 1, and the treat all, Group 2, had greater benefits and lower costs than Group 3, who received no decolonization. 2012;9:CD004985.9. Chlorhexidine gluconate versus povidone iodine at cesarean delivery: a randomized controlled trial. Use CHG wash for 5 days prior to surgery and morning of surgery. Scope of the EBPs will only help to hold each other and each Department accountable for the process ( 3 ), 996-1011 ( evaluating outcomes ) was completed M., Moorhead S. ( 2014 ) back Current Joint Center Committee, the JHNEBP appraisal tools ( American nurses association, 2014.! 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