Surgical site infection

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

2. 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]).

3. What this presentation covers • Background • Scope • Key priorities for implementation • Costs and savings • Discussion • Find out more

4. 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

5. 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

6. Key priorities for implementation • Information for patients and carers • Preoperative phase • Intraoperative phase • Postoperative phase

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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?

14. Find out more • Visit www.nice.org.uk/CG74 for: • Other guideline formats • A costing statement • Audit support