PW HIPKABI

Perioperative
Nursing Prevent
to Surgical site
Infection
Reduction

7th BSCORN
 Edy Purwanto
Trainer HIPKABI - Mediator

Address
Puri Asri Lestari A14 Madiun

Contact Info
edypotternew@gmail.com
edy.purwanto-2017@fkp.unair.ac.id
edypotter28@yahoo.co.id
Telephone
HP : 082330442491
Office Phone : (0351)464325 – pswt : 410

Office :
OK Pav. Merpati RSUD dr. Soedono Madiun
Mediasi & Advokasi Madiun center (MAMC)

Mengabdi Melayani Demi Kemajuan Profesi

Curiculum
Vitae
 Hari ini adalah hari terbaik untuk
dimanfaatkan dan hari ini adalah hari
terindah untuk kita syukuri
 TUJUAN UMUM
Setelah pelatihan ini peserta mampu untuk :

Memahami
Pencegahan dan Pengendalian
Infeksi di Kamar Bedah

Surgical Site Infections

 I.D.O
Infeksi Daerah Operasi

Adalah infeksi yang terjadi ketika

microorganisme dari
kulit, bagian tubuh lain atau lingkungan
masuk kedalam luka insisi yang
terjadi dalam waktu 30 hari dan jika ada
implant terjadi 1 tahun pasca operasi
(awad et all, 2009)
 Wound Classification algoritm
Did you encaunter :
Open traumatic wounds > 4 hours ?
Penetrating injuries > 4 hours ? Class IV
Yes >30%
Perforated viscera ? Dirty Infected
Purulence/existing clinical infections ?
Retained devitalized tissue ?

No
Did you encaunter :
Acute, non purulent inflamations ?
Gross(any) spilage from the GIT (biles) ? Class III >15%
Yes
Infarcted or necrotic bowel ? Contaminated
Major break in steril technique ?
Other necrotic tissue
No
Did you encaunter : Class II
The GI , genitourinary, or respiratory tracts Yes 5-15%
Clean-Contaminated

No

Class I < 2%
Clean
Zinn J, Swofford V, 2016
CDC Classifications
of

Surgical site
Infections
Microbiology of SSIs
Annual
Infection Number of Total Annual Cost to
Type Infections Hospitals
Bloodstream
248,678 $5,779,774,076
Infections
PseudomonasStaphylococcus SSI 290,485 $3,033,534,855
aeruginosa aureus
8% 20% Urinary Tract
561,667 $425,743,586
Enterococcus
Infections
spp.
12% Pneumonia VAP 250,205 $6,273,139,760

Escherichia According to the CDC, HAIs

Coagulase neg.
coli staphylococci accounted for an estimated 1.7
8% 14% million infections and
99,000 deaths annually
Incidence of SSI in several countries around
the world

Published online 30 October 2014

ALOS
Cost
 Patient
 Endogenous flora of the
patient

Source of
SSI Pathogens Environment
 Operating theater
environment

Personal
 Hospital personnel
(MDS/RNS/STAFF

Implant
 Seeding of the operative site
from distant focus of infection
(prosthetic device, implants)
 SSI Risk Factors
 Age
 Diabetes
 Obesity
 Malnutrition
 Nicotin use
 Operation technik

Prolonged Systemic Hair Inappropriate

preoperative
steroid use removal/Sh use of
stay
. aving antimicrobial
.
prophylaxis
.
 Strategis For Prevention of SSI (bundle)

0 0 0
1 3 5

0 0
2 4
Ev. Based Guidline CDC Recommend the following Preventive measure, 2016
Pre operative
Preoperative
Showering
Removes microorganisms from
skin
Many SSIs result from
colonization with patient’s own
flora
2% or 4% CHG is more effective
than PI or soap
More than one shower is
necessary to achieve maximum
effectiveness
Preoperative
Showering
 Most studies examine effects on skin
colony counts antiseptic showering
decreases colony counts

 Few studies examine effect on SSI rates

No Shower
Shower
Cruse, 1973 2.3%
1.3%
Ayliffe, 1983 4.9%
4.4%
Rooter, 1988 2.4%
1.6%
 Antibiotik Profilaksis

• Prospective study of 2,847 elective clean and

clean-contaminated procedures

• Early AP (2-24 hrs before incision): 3.8%

Postop AP (3-24 hrs after incision): 3.3%
Periop AP (< 3 hrs after incision): 1.4%
Preop AP (<2 hrs before incision): 0.6%
 H.O Hair Removal

 Shaving increases risk for SSI

 Hair removal should be performed
 on the day of surgery
 Hair removal inside or
outside the OR
 using a clipper
 Only interfering hair should be
removed
 Hair Removal
Seropian, 1971
Method of hair removal
Razor = 5.6% SSI rates
Depilatory = 0.6% SSI rates
No hair removal = 0.6% SSI rates

Timing of hair removal

Shaving immediately before = 3.1% SSI rates
Shaving  24 hours before = 7.1% SSI rates
Shaving >24 hours before = 20% SSI rates
Surgical skin preparation

 The panel recommends

alcohol-based antiseptic
solutions based on CHG for
surgical site skin
(Strong recommendation, low
to moderate quality of
evidence)
 Surgical site preparation
 The panel recommends
alcohol-based antiseptic
solutions based on CHG
for surgical site skin
(Strong recommendation, low to
moderate quality of evidence)
Skin cannot be sterilized, it is
mechanically cleansed and chemically
decontaminated to reduce skin flora
Environment
Environment
Parameter
s for
Operating
Room
Ventilatio • Temperatur 19-24 C
n •
•
Intensitas cahaya min luximal 200
Humidity should be maintained between 20% - 60%
• Low humidity increases potential for dust
• High humidity increases microbial growth
 Surgical
hand
scrubbing
 Gowning Gloving
The panel suggests not to use
plastic adhesive incise drapes
with or without antimicrobial
properties for the purpose of
preventing SSI
The panel suggests that either
sterile, disposable, non-woven or
sterile, reusable woven drapes
and surgical gowns can be used
during surgical operations for the
purpose of preventing SSI
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