Latest / Culture Positive: An Infection Prevention Podcast / Incision, Infection, Prevention
Transcript
- Ally: Welcome to Culture Positive, an infection prevention podcast where healthcare, public health, and real life meet. I'm Allie, and by day I work in infection prevention at an academic hospital, bringing my background in epidemiology and public health into everyday practice. Each week, We'll dive into healthcare stories, public health conversations, workplace realities, and the human side of this work. This is a space for curiosity, honesty, and hopefully some inspiration. I'm glad you're here. Surgery has been a part of human healthcare for thousands of years. Did you know we have skeletal evidence that a surgical amputation was performed 31,000 years ago? Researchers discovered skeletal remains in Borneo, showing that an individual had undergone a surgical amputation of their lower left leg. Here is the crazy part: it is believed this person survived the procedure. And went on to live for another six to nine years. There are so many examples of various surgical interventions throughout history. The Epers papyrus, an ancient Egyptian medical text dating back to around 1550 BCE, describes surgical procedures for crocodile bites. In 1540, barber surgeons in England were performing procedures like tooth extractions. Fast forward to 1896 when German surgeon Ludwig Wren successfully repaired a stab wound to the heart, the first successful open heart surgery. In 1967, Thomas Darzel performed the first successful human liver transplant at what is now the University of Colorado Hospital. And in 2022, surgeons at the University of Maryland Medical Center transplanted a genetically modified pig's heart into a human for the first time. I mean, when you look at the advancements we've seen in medicine, and surgery in particular, the progress is pretty incredible. Surgery today looks very different from what it did even a few decades ago. Ambulatory surgical centers, for example, have become increasingly common, allowing patients to check in, have their procedure, recover, and go home all in the same day. Chances are You know someone who has had surgery. Maybe you've even had surgery yourself. But with surgery does come risk. And one of the things we monitor in infection prevention is healthcare-associated infections, also known as HAIs. Surgical site infections, or SSIs, fall under that umbrella. There are so many different types of surgeries to monitor, so many factors that can contribute to an infection. And many lessons we have learned from investigating these cases. Surgical sight infections. Let's get into it. Before we dive into SSIs, this is an episode request from a listener. Hi, Amanda's mom. Thank you so much for listening. If there are any topics you want me to cover, episode ideas, or even just want to say hi, I would love to hear from you. please email me at culturepositivepod at gmail.com or send me a DM on Instagram at CulturePositive Pod. I look forward to hearing from you. Okay, back to SSIs. What is a surgical sight infection? Well, it's pretty much what it sounds like: an infection that occurs in part of the body where surgery took place. In general, surgical sight infections Typically occur within 30 days of the surgery, but that is not always the case. Depending on the type of procedure and infection, surveillance for SSIs can actually be 30 or 90 days. Surveillance for SSIs is typically work done by an infection preventionist or hospital epidemiologist. The investigations are very detailed. And take a lot of time and effort to review patient charts. Remember how I said surveillance period can be for 30 or 90 days based on the surgery or procedure? That can mean a lot of chart review. Anyway, surgical sight infections. There are three main categories that every SSI will fall into: superficial, incisional. Deep incisional and organ or space. A superficial incisional SSI involves the skin and subcutaneous tissue around the incision. A deep incisional SSI occurs deeper beneath the incision and can involve the fascia and muscle layers. Finally, an organ or space SSI involves a part of the body deeper than those tissue layers that was manipulated or involved during the surgical procedure. This could be an organ or space between organs. Similar to catheter associated urinary tract infections, known as COTIS, and central line associated bloodstream infections, known as clapsis, SSIs will also be reported to NHSN, the National Healthcare Safety Network. So, how does one even become aware of a possible SSI? Obviously, we have to have surgery, but then we start with signs and symptoms. When we think about signs and symptoms associated with a possible SSI, that can include fever or chills, redness or warmth around the incision, the incision itself opening, drainage or pus coming from the surgical site, or a change in the appearance or odor of the site itself. If you've recently had surgery and noticed any signs of a possible infection, It is important to contact your healthcare provider. During a follow-up visit, it is possible you might get a prescription for antibiotics, received wound care, and sometimes it might require another surgery. Hopefully yourself, your loved ones, or your patients never experience this, but when infection preventionists are sent a case to review, here are the questions we really want to answer. How did this infection happen? What organism caused it? Anything unusual about the case noted? And ultimately, was there an opportunity to prevent the infection from happening? Any patient safety professional or member of a care team believes strongly in providing the best possible care and giving patients the best opportunity for a positive outcome. And for infection preventionists, Preventing infection is literally in our title. When we're talking about preventing SSIs, you'll often hear infection preventionists and other members of the care team talk about an SSI prevention bundle. A bundle is essentially a group of evidence-based practices that, when performed together and consistently, can help reduce the risk of infection. So let's briefly talk through some of the items that can be included in this bundle. Prevention actually starts before a patient ever enters the hospital. If you have a scheduled surgery, you may be given instructions to bathe or shower before your procedure using a special antiseptic soap, often chlorohexidine or CHG. I probably say the word chlorohexidine at least 20 times a week. CHG is a broad spectrum antiseptic that reduces microorganisms on the skin. And that's important because our skin is covered in microorganisms all the time. And when we think about surgery and putting an incision on someone's skin, all those microorganisms are given a chance to enter the body. CHG is a great first step in reducing the patient's risk for developing an infection. Step one, if you will, for an SSI prevention bundle. Aside from prepping the skin with CHG, other elements of SSI prevention bundle can include proper hand hygiene, and donning and doffing of personal protective equipment by operating room staff, disinfection and sterilization of medical equipment, and the overall environment of the operating room, also known as the OR. With the OR itself, We need to be mindful of the temperature and humidity of the space, keeping positive pressure, and overall cleanliness. Of course, when you're a post-surgery, we want to make sure the incision site is kept clean with keeping the dressings clean and whenever a dressing change is needed. Hand hygiene and clean gloves are used. As I will continue to say, good hand hygiene is the number one way to prevent infections. Wash those hands. Prevention bundles have proven to help prevent infections, and there are studies to prove it. I can link a few studies in the episode notes for anyone who is curious or is looking for any guidance for implementing different action items to their own SSI prevention bundle. This prevention work is so important because SSIs can cause illness and sometimes death for a patient. How common are surgical site infections? It has been estimated that SSIs affect 2 to 4% of patients who undergo inpatient surgical procedures in the United States. And while that sounds like a relatively small percentage, when you consider how many surgeries are performed every year, those numbers add up quickly. SSIs account for about20 of all hospital-acquired infections. And they are associated with a 2 to 11 fold increase in the risk of death. In the United States alone, an estimated 157,500 SSI cases were reported in 2018, and approximately 8,200 of those cases resulted in death. SSIs can also have a major impact on a patient's recovery and can lead to more time in the hospital. Patients who develop a surgical site infection can spend 10 to 11 additional days in the hospital, compared with patients who don't develop an infection. Think about what that means for the patient. Instead of being in the comfort of their own home, they need to be in the hospital for an additional week or longer. They can need antibiotics to help treat the infection, imaging that needs to be done, wound care, and possibly Another surgery. Preventing SSIs not only prevents a patient from getting an infection, but it allows for patients to have a quicker recovery, decrease possible complications in care, and the need for a longer hospitalization. It leads to better patient outcomes and also less burden on a healthcare facility. As is most of the work with infection prevention, it's valuable on so many levels. At the core, we are protecting patients. But when we take a wider view in protecting patients and their health, we are getting them discharged out of the hospital without delays. This is a benefit for not only the patient, but also the hospital. Fewer days in the hospital means we can free up beds and help other patients who need that care. And then there's the business perspective. Surgical site infections can be incredibly costly. For both patients and hospitals. An SSI can increase the cost of a hospitalization by an estimated $20,000 or more. And the estimated annual cost of SSIs in the United States is between 3.3 and 10 billion dollars. So when we talk about preventing an SSI, we're not just talking about preventing an infection. We are talking about protecting patients, but also improving patient flow in a hospital, making better use of hospital resources, and reducing overall costs. So, how can you better advocate for your patients if you're an infection preventionist? Start by reviewing your prevention bundles. The CDC, the Joint Commission, and APIC all have amazing resources that can help you identify evidence-based practices and lead you to figuring out what works best for your facility. Partner with your OR colleagues. Do OR observations. You can learn so much by simply watching people do the work in real time. It gives you a completely different perspective than looking at a policy or reviewing data from behind a computer screen. You get to see what's working, where the barriers are, and where there may be opportunities to improve. If you're listening to this and you're scheduled to have surgery, or you have a loved one who is, you can absolutely ask questions. Ask what measures are being taken to prevent infection. Ask about the hospital surgical site prevention practices. Ask what follow-up will look like after surgery, including what to watch out for with your incision, and who you should contact if you have concerns. I know it can feel intimidating, but please always ask questions. You are allowed to understand what is happening to you and the why behind it. Good infection prevention is a team effort. It involves the IP, the surgical team, nurses, physicians, environmental services, patients and families. We all have a role to play in keeping patients safe and preventing SSIs. For our huddle corner, a section for some takeaways before signing off. Surgeries have been happening for thousands of years, but we are still innovating and learning how to best keep patients safe. Surgical site infections are a reportable condition and account for about20% to of all hospital-acquired infections and hospitals. We utilize a bundle that consists of best practices that can help reduce the risk of infection. But there is always work to be done. Always remember whether you are an infection preventionist, surgeon, nurse, patient, or family member, we are all a part of the infection prevention team. So advocate for your patients. Advocate for yourself. Ask questions. Speak up. And remember that sometimes the smallest action can make a big difference. In keeping someone safe. Thank you for listening to Culture Positive. If you have any questions or ideas for an episode, please send me an email at CulturePositive Pod at gmail.com. You can also Thank you for listening to Culture Positive. If you have any questi Nope. find me on Instagram at CulturePositive Pod. Please like, share, and review the podcast wherever you listen. References for the episode can be found in the notes. Infection prevention is about more than policies and protocols. It's about people. Until next time, stay curious, stay compassionate, and keep building a culture that's truly positive.