Prevent wound infection

(Ban hành kèm theo Quyết định số: 3671/QĐ-BYT ngày 27 tháng 9 năm 2012 của Bộ Y tế)

Hạc Huyền My - 36APN

Vũ Thị Lý - 36APN
Content
1. Introduction
1.1. Concept of wound infection
1.2. The situation and consequences of wound infection
1.3. The situation and consequences of wound infection
1.4. Scope of application
2. Pathogenesis and risk factors
2.1. Pathogens
2.2. Pathogen sources and genetic mechanisms
2.3. Risk factors for wound infection
3. Preventive measures
3.1. General principles
3.2. Preventive measures
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 Introduction
1.1. Concept of wound infection

Surgical site infections are infections at the

surgical site from the time of surgery to 30

days after surgery with surgery without

implants and up to one year after surgery with

surgery with prosthetic implants (surgery

implant technique)
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 Introduction
1.2. The situation and consequences of wound infection

- In the United States, NKVM ranks second after hospital

urinary infections
- Every year, the number of patients infected with ARI is
estimated about 2 million people
- In Vietnam, ARI occurs in 5% - 10% of about 2 million
patients receiving surgery every year. It is the most common
bacterial infection, with the largest number of hospital
infections. Approximately 90% of these is shallow and deep.
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 Introduction
1.2. The situation and consequences of wound infection

- Wound infection has serious consequences for the patient due to prolonged hospitalization,

increased mortality and increased treatment costs.

- NKVM accounts for 89% of the cause of death in patients with deep respiratory infections. With
some special surgeries such as transplant surgery, hospital infection has the highest cost compared
to other dangerous surgical complications and increases the average hospital stay of more than 30
days.
- A few studies in Vietnam showed that ARV increased 2 times the hospital stay and direct
treatment costs.

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 Introduction
1.3. The situation and consequences of wound infection
Measures have been found to be highly effective in preventing wound infections, including:
(1) Bathe with antiseptic soap for the patient before 5) Strictly follow the aseptic procedure in the operating
surgery; room and when taking care of the incision, etc.
(2) Remove hair and prepare skin incision properly 6) Control blood sugar, warm the patient during surgery

(3) Surgical and routine hand disinfection with an (7) Maintain aseptic conditions in the operating area such

alcohol-based hand sanitizer as tools, surgical fabrics that are properly sterilized, sterile
water for surgical hand hygiene and clean air in the
(4) Correctly apply prophylactic antibiotic therapy
operating room.

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 Introduction
1.4. Scope of application

All medical examination and treatment facilities with surgery,

members of surgical crew, surgical staff, patients undergoing surgery,
family members of the patients undergoing surgery, visitors and all
other health workers perform the activities. Medical, technical in the
surgical area should strictly adhere to these regulations and procedures.

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 Pathogenesis and risk factors
2.1. Pathogens

- Bacteria are the main cause of

infection, followed by fungus

Bảng. Các chủng vi khuẩn gây

NKVM thường gặp ở một số phẫu
thuật.

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 Pathogenesis and risk factors
2.2. Pathogen sources and genetic mechanisms
There are 2 sources of causes , including:
Microorganisms in the patient (endogenous)
Microbiological environmental (exogenous)
Is the main source of the cause of viral infections,
The microorganisms outside the environment enter
including microorganisms that are present on the
incision during surgery or while caring for the incision.
patient's body. These microorganisms often reside
The exogenous pathogens often originate from:
in the epidermal cells of the skin, mucous
+ The operating environment
membranes or in the hollow organs / organs of the
+ Tools, materials to stop bleeding, surgical
body. Endogenous pathogens often originate from
fabrics polluted.
the hospital environment and are highly resistant to
+ Surgery staff
drugs. . 12
 Pathogenesis and risk factors
2.3. Risk factors for wound infection
There are 4 groups of risk factors for infections, including:
patient, environment, surgery, and pathogens.
• - Patient factors: The worse the patient's condition before surgery, the higher the risk
• - Environmental factors: Surgical hand hygiene, surgical conditions (operating room,
tools ...) are not sterile, medical staff, ...
• - Surgical factors: surgical timing and operations; type of surgery, ...
• - Microbiological factors: The higher the pollution, virulence and antibiotic resistance of
bacteria, the weaker the resistance of the surgical patient, the greater the risk.

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 Preventive measures
3.1. General rules
 All medical staff, patient's family members and patients should
conform to the rules and procedures before, during and after
surgery.
 Use antibiotic prophylaxis suitable for the pathogen, the right dose,
time and route of administration.
 Regularly and periodically monitoring; communicate the results to
the relevant people.
 Equipment, conditions, facilities, consumables and chemicals
essential for aseptic practice of patient care. 14
 Preventive measures
3.2.1: Prepare the patient for surgery

- Quantitative blood glucose and quantitative tests of serum albumin for all patients
undergoing session surgery.
- Detect and treat any infected
- Shorten preoperative hospital stay for prepared surgeries.
- The patient must be showered with a disinfectant soap containing iodine or chlorhexidine
the night before the surgery and / or the morning of the surgery. The patient can dry bath in
a way to disinfect the entire skin of the body, especially the skin of the surgical area
- No hair removal before surgery, except for cranial surgery patients or patients with hairs at
the incision site. The skin affects operations during surgery. For patients with an indication
for hair removal, it is necessary to remove hair in the operating area, performed by the
health worker within 1 hour before surgery. Use shears or an electric razor to remove hair,
do not use a razor. 15
 Preventive measures
3.2.2: Use of prophylactic antibiotics in surgery

 Using antibiotic prophylaxis with clean and clean surgery - infection.

Antibiotic prophylaxis needs a short dose right before surgery.
 Using antibiotic prophylaxis should comply with the following 4
principles:
• Selection of antibiotics sensitive
• Antibiotic prophylaxis injection within 30 minutes before skin incision.
• Maintain standard concentration in serum and tissue.
• Do not take antibiotic prophylaxis for longer than 24 hours after surgery.

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 Preventive measures
3.2.3. Preventive measures in surgery

- The operating chamber door must always be closed.

- Limit the number of health workers entering sterile areas of the operating area and the
operating room.
- All medical staff must conform to the rule when entering the surgical site.
- Members directly involved in surgery must clean their hands with an antiseptic solution.
- Members who are not directly involved in surgery must clean their hands with an alcohol.
- Everyone who has entered the operating room should limit walking or going out of the
operating room and limit hand contact with the environmental surface in the operating
room.
- Prepare the skin for the surgical area.
- Surgical technique.

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 Preventive measures
3.2.4. Post-operative care

- Cover the incision with sterile gauze continuously from 24-48 hours after surgery.
- Change the dressing according to the aseptic procedure.
- Instruct the patient and the patient's family to follow up, detect and immediately notify the health
worker when the incision shows unusual signs / symptoms.
- Take care of the drain legs in accordance with the technical process and need to drain the drain as
soon as possible.

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 Preventive measures
3.2.5. Supervision to detect incision bacteria

- Organizing surveillance and detection of respiratory tract infections in surgical patients.

- Use active, prospective, and direct surveillance method.
- Use the US Center for Disease Prevention (CDC) definition for wound infection.
- Before surgery, the anesthesia team needs to classify and record in the medical history of the
patient before surgery according to the ASA scale of the American Anesthesia Association,
1992.
- Immediately after the operation, a member of the surgical team must record in the medical
record the time of surgery and the type of incision.
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 Preventive measures
Bảng thang điểm ASA của hội gây mê Hoa Kỳ, 1992

Điểm ASA Tiêu chuẩn phân loại

1 điểm Người bệnh khoẻ mạnh, không có bệnh toàn thân

2 điểm Người bệnh khoẻ mạnh, có bệnh toàn thân nhẹ

3 điểm Người bệnh có bệnh toàn thân nặng nhưng vẫn hoạt động bình thường

4 điểm Người bệnh có bệnh toàn thân nặng, đe dọa tính mạng

5 điểm Người bệnh trong tình trạng bệnh nặng, có nguy cơ tử vong cao cho dù được phẫu
thuật

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 Preventive measures
Bảng phân loại vết mổ và nguy cơ NKVM
Loại vết mổ Định nghĩa Nguy cơ NKVM (%)

Sạch Là những phẫu thuật không có nhiễm khuẩn, không mở vào đường hô hấp, tiêu hóa, sinh dục và tiết niệu. Các vết thương sạch 1-5
được đóng kín kỳ đầu hoặc được dẫn lưu kín. Các phẫu thuật sau chấn thương kín.

Sạch nhiễm Là các phẫu thuật mở vào đường hô hấp, tiêu hoá, sinh dục và tiết niệu trong điều kiện có kiểm soát và không bị ô nhiễm bất 5-10
thường. Trong trường hợp đặc biệt, các phẫu thuật đường mật, ruột thừa, âm đạo và hầu họng được xếp vào loại vết mổ sạch
nhiễm nếu không thấy có bằng chứng nhiễm khuẩn/ không phạm phải lỗi vô khuẩn trong khi mổ.

Nhiễm Các vết thương hở, chấn thương có kèm vết thương mới hoặc những phẫu thuật để xảy ra lỗi vô khuẩn lớn hoặc phẫu thuật để 10-15
thoát lượng lớn dịch từ đường tiêu hoá. Những phẫu thuật mở vào đường sinh dục tiết niệu, đường mật có nhiễm khuẩn, phẫu
thuật tại những vị trí có nhiễm khuẩn cấp tính nhưng chưa hóa mủ.

Bẩn Các chấn thương cũ kèm theo mô chết, dị vật hoặc ô nhiễm phân. Các phẫu thuật có nhiễm khuẩn rõ hoặc có mủ. >25

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 Preventive measures
3.2.5. Supervision to detect incision bacteria

- Use the uniform surveillance of vascular infection during the monitoring sessions.
- The monitoring group should calculate the rate of ARI according to each type of
surgery and according to the variables to determine the risk factors.
- The Department / Team is responsible for coordinating with relevant departments
and departments to develop intervention plans, submit to hospital leaders for
approval, and organize the implementation of improving the shortcomings obtained
from monitoring activities.
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 Preventive measures
3.2.6. Check and monitor compliance with sterile procedures in health workers

- Organize a quarterly monitoring of compliance with regulations / procedures for hospital

infection prevention of surgical staff.

- After being approved by the hospital director, the results of monitoring should be informed to
surgeons, members involved and the infection control network.
- The infection control department should propose a plan for approval and implement the
improvement of the shortcomings obtained from monitoring activities.

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 Preventive measures
3.2.7. Ensure essential equipment and equipment conditions and chemicals for the prevention of malaria

- Surgical area design must comply with regulations of the Ministry of Health.
- Ventilation of the operating room.
- Temperature and humidity in the operating room.
- Arranging and disinfecting the surface of the operating room environment.
- Always have personal protective equipment available at the entrance to the sterile area
of ​the operating area.
- Fully equipped facilities for surgical and routine hand hygiene.
- Sterilize tools, hemostatic materials and surgical fabrics.

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 Preventive measures
Bảng tiêu chuẩn vi khuẩn cho không khí buồng phẫu thuật

Tiêu chuẩn VK cho buồng phẫu thuật thường:

Phòng mổ trống <35 / m3 (bcpm-3), phòng đang mổ <180 bcpm-3

Tiêu chuẩn VK cho buồng phẫu thuật siêu sạch:

Khí lưu chuyển: 0.3 ms-1 (phòng kín), 0.2 (phòng hở)
VK ở vị trí cách 1 mét từ sàn nhà tại buồng phẫu thuật trống: < 1 bcpm -3
VK ở vị trí ngang bàn mổ trong khi đang mổ: < 10 bcpm -3
Nếu hệ thống buồng phẫu thuật không hoàn toàn kín, VK ở mỗi góc phòng < 20
bcpm-3

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 Preventive measures
3.2.8. Several other measures to prevent wound infections

- Spray and disinfect the operating room air .

- Waste generated from each surgery should be classified, collected and isolated immediately
according to the medical waste management regulations of the Ministry of Health.
- Fabrics used for each surgery should be collected into a waterproof bag / bin and sent to the
laundry after each surgery.
- Take samples for microbiological tests of operating room environment (air, environmental
surface of the operating room, water for surgical hand hygiene), surgical tools twice a year
and after each repair, renovate the surgical site or when it is suspected that an epidemic has
occurred. Take immediate corrective measures if the environmental test results exceed the
specified standards.
- Prevent occupational exposure to blood-borne pathogens in health workers according to
regulations of the Ministry of Health.
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Thank you