INFECTION CONTROL NEWSLETTER

July 1999
written by and for Long Term Care Infection Control Nurses

Broad Street Solutions
James Marx, RN, MS, CIC Editor
PO Box 16557
San Diego, CA 92176
(619) 656-7887 Voice/FAX
jmarx@concentric.net

Surgical Site Infections

While it is unlikely that a surgical site infection can be prevented by the care provided in a skilled nursing facility, infection control nurses should be aware of interventions which do prevent surgical site infections.

Almost all surgical site infections are a result of actions which occur before and during the surgical procedure. A surgical site infection is considered nosocomial if clinical signs and symptoms occur with 30 days after surgery, and 1 year for implantable devices. Postoperative incisional care includes the following:

Protect with a sterile dressing for 24 to 48 hours postoperatively.
Wash hands before and after dressing changes and any contact with the surgical site.
When an incision dressing is changed, use sterile technique (Note: This applies for the first 24 to 48 hours only)
Educate the patient and family regarding proper incision care, symptoms of surgical site infection and the need to report such symptoms.
There is no recommendation to cover the incision beyond 48 hours, nor on the appropriate time to shower or bathe with an uncovered incision.

Definition of surgical site infection includes:

Purulent drainage, with or without laboratory confirmation from the incisional site OR
Organisms isolated from an aseptically obtained culture OR
Pain, tenderness, localized swelling, redness or heat plus the physician deliberately opens the surgical site OR
physician diagnosis of infection

Pathogens isolated from surgical sites are Staphylococcus aureus, Coagulase-negative staphylococci, Entercococcus spp., Escherichia coli, Pseudomonas aeruginosa, Enterbacter spp. and others.

Factors that may influence the risk of surgical site infection:

Patient

Age
Nutritional Status
Smoking
Diabetes
Obesity
Coexistent infections at a remote body site
Colonization with microorganisms
Altered immune response
Length of preoperative stay

Operation

Duration of Operation
Skin antisepsis
Preoperative shaving
Antimicrobial prophylaxis
Surgical drains
Surgical technique

If you discover a surgical site infection, it should be reported to the infection control nurse at the facility where the surgery took place. Some hospitals track surgical site infections for specific surgeries.

For more information read the Guideline for Prevention of Surgical Site Infections, 1999. Amer J of Infection Control, April 1999. This is also available on the internet, www.apic.org

Did you Know...

..that hepatitis B vaccination is now required for entry to kindergarten?
... that restaurants in California must cook your hamburger to 165 F, unless you specifically request otherwise?
... that varicella vaccine is recommended for your employees who have never had chickenpox?
... that influenza vaccine can not cause influenza?
... that tuberculosis was the leading cause of death 100 years ago?
... that someone with a positive TB skin test has a 10% lifetime chance of getting sick with TB?

Late Breaking News...

California OSHA has issued a proposed amendment to the Bloodborne Pathogens Standard, seven years after the Standard became final in 1991. While the proposed changes are in draft form, several organizations will be sending written comments; including the California Association of Healthcare facilities (CAHF) and APIC.

Highlights of the Proposed changes:

Requires a program to identify and evaluate the safest needle devices on the market
Requires the use of needleless IV systems
Requires use of safety syringes for medication administration
Requires safety devices for blood drawing
Requires hepatitis C testing after a blood exposure
Allows the employee's health plan to cover the cost of hepatitis B vaccine, if the employer pays all costs for the health plan and deductibles
Requires blood testing after hepatitis B vaccination to see if the vaccine produced a response. For non-responders, a second vaccine series is required followed by another blood test.
Requires documentation of the type and brand of device used during an exposure incident

If this is passed in California, it is likely to be passed by Federal OSHA and other State OSHA agencies. More news will be published as it becomes available.