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
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]).
What this presentation covers • Background • Scope • Key priorities for implementation • Costs and savings • Discussion • Find out more
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
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
Key priorities for implementation • Information for patients and carers • Preoperative phase • Intraoperative phase • Postoperative phase
Information for patients and carers • Offer patients and carers clear, consistent information and advice throughout all stages of their care
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
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
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
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
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
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?
Find out more • Visit www.nice.org.uk/CG74 for: • Other guideline formats • A costing statement • Audit support