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Surgical site infection. Implementing NICE guidance. 2008. NICE clinical guideline 74. Updated guidance.

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Surgical site infection

Implementing NICE guidance

2008

NICE clinical guideline 74


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Updated guidance

  • This guideline updates and replaces ‘Guidance on the use of debriding agents and specialist wound care clinics for difficult to heal surgical wounds’ (NICE technology appraisal guidance 24 [published April 2001]).


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What this presentation covers

  • Background

  • Scope

  • Key priorities for implementation

  • Costs and savings

  • Discussion

  • Find out more


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Background

  • Surgical site infections (SSI):

  • Are largely preventable

  • Can have a significant effect on quality of life for the patient

  • Result in a considerable financial burden to healthcare providers

  • Compose up to 20% of all healthcare-associated infections

  • Develop in at least 5% of patients having surgery


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Scope

  • The guidelinecovers all patients, both adults and children, having surgical incisions through the skin

  • The guideline covers both acute hospital trusts and primary healthcare settings


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Key priorities for implementation

  • Information for patients and carers

  • Preoperative phase

  • Intraoperative phase

  • Postoperative phase


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Information for patients and carers

  • Offer patients and carers clear, consistent information and advice throughout all stages of their care


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Preoperative phase (hair removal)

  • Do not use hair removal routinely

  • Do not use razors for hair removal, because they increase the risk of surgical site infection

  • If hair has to be removed, use electric clippers with a single-use head on the day of surgery


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Preoperative phase(antibiotic prophylaxis)

  • Give antibiotic prophylaxis to patients before;clean surgery involving the placement of a prosthesis or implant, clean-contaminated surgery and contaminated surgery

  • Do not use prophylaxis routinely for clean non-prosthetic uncomplicated surgery

  • Use the local antibiotic formulary and always consider potential adverse effects when choosing specific antibiotics for prophylaxis

  • Consider giving prophylaxis on starting anaesthesia, or earlier for operations using a tourniquet


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Intraoperative phase

  • Prepare the skin immediately before incision using an (aqueous or alcohol-based) antiseptic preparation - povidone‑iodine or chlorhexidine are most suitable

  • Cover surgical incisions with an appropriate interactive dressing at the end of the operation


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Postoperative phase

  • Refer to a tissue viability nurse (or another healthcare professional with tissue viability expertise) for advice on appropriate dressingsfor the management of surgical wounds that are healing by secondary intention


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Costs and savings

  • The guideline on surgical site infection is unlikely to have a significant national resource impact in the NHS

  • Recommendations that may have local resource impact are:

    • Information for patients

    • Hair removal

    • Wound dressings

    • Optimising blood glucose levels

    • Maintaining patient homeostasis


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For discussion

  • What information about surgical site infection is given to patients and carers? When and how is it given?

  • What structures and processes are there in place to ensure best practice in the care of surgical wounds (e.g. Wound management formulary)?

  • How accessible is a tissue viability nurse (or similar) for advice on dressings?


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Find out more

  • Visit www.nice.org.uk/CG74 for:

    • Other guideline formats

    • A costing statement

    • Audit support


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