Surgical Site Infection & Surgery Healing Problems

Malpractice can occur if the infection was from a negligence or abnormal procedure. Surgical site infections occur in 2-5% of clean extra-abdominal surgeries and up to 20% of intra-abdominal surgeries. Each infection is estimated to increase a hospital stay by an average of 7 days and add over $3,000 in charges (1992 data). Patients who develop surgical site infections are sixty percent more likely to spend time in an ICU, five times more likely to be readmitted to the hospital and have twice the incidence of mortality.

Despite advances in infection control practices, surgical site infections remain a substantial cause of morbidity and mortality among hospitalized patients. Studies indicate that appropriate preoperative administration of antibiotics is effective in preventing infection.

Contact our Minnesota & Wisconsin Personal Injury Attorneys if you suspect surgry infection negligence.

Systemic and process changes that promote compliance with established guidelines and standards can decrease infectious morbidity.

The Following are Government recommendations for doctors, hospital, and surgery personnel to follow to greatly decrease the chances of infections from surgery.

If these standards were not followed and a severe infection developed the health care agent may be found liable.

MAJOR RECOMMENDATIONS

Please note: June 6, 2003 Guidelines for Environmental Infection Control in Health-Care Facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC), published by the Centers for Disease Control and Prevention (CDC) updates operating room ventilation and surface cleaning/disinfection recommendations from the section in this guideline titled "Intraoperative Issues: Operating Room Environment."

Categories of recommendations (IA, IB, II, Unresolved issue, and *) are defined at the end of the Major Recommendations field.

Preoperative

Preparation of the patient

1. Whenever possible, identify and treat all infections remote to the surgical site before elective operation and postpone elective operations on patients with remote site infections until the infection has resolved. Category IA
2. Do not remove hair preoperatively unless the hair at or around the incision site will interfere with the operation. Category IA
3. If hair is removed, remove immediately before the operation, preferably with electric clippers. Category IA
4. Adequately control serum blood glucose levels in all diabetic patients and particularly avoid hyperglycemia perioperatively. Category IB
5. Encourage tobacco cessation. At minimum, instruct patients to abstain for at least 30 days before elective operation from smoking cigarettes, cigars, pipes, or any other form of tobacco consumption (e.g., chewing/dipping). Category IB
6. Do not withhold necessary blood products from surgical patients as a means to prevent surgical site infections (SSI). Category IB
7. Require patients to shower or bathe with an antiseptic agent on at least the night before the operative day. Category IB
8. Thoroughly wash and clean at and around the incision site to remove gross contamination before performing antiseptic skin preparation. Category IB
9. Use an appropriate antiseptic agent for skin preparation. Category IB
10. Apply preoperative antiseptic skin preparation in concentric circles moving toward the periphery. The prepared area must be large enough to extend the incision or create new incisions or drain sites, if necessary. Category II
11. Keep preoperative hospital stay as short as possible while allowing for adequate preoperative preparation of the patient. Category II
12. No recommendation to taper or discontinue systemic steroid use (when medically permissible) before elective operation. Unresolved issue
13. No recommendation to enhance nutritional support for surgical patients solely as a means to prevent SSI. Unresolved issue
14. No recommendation to preoperatively apply mupirocin to nares to prevent SSI. Unresolved issue
15. No recommendation to provide measures that enhance wound space oxygenation to prevent SSI. Unresolved issue
    
    Hand/forearm antisepsis for surgical team members
    
• Keep nails short and do not wear artificial nails. Category IB
• Perform a preoperative surgical scrub for at least 2 to 5 minutes using an appropriate antiseptic. Scrub the hands and forearms up to the elbows. Category IB
• After performing the surgical scrub, keep hands up and away from the body (elbows in flexed position) so that water runs from the tips of the fingers toward the elbows. Dry hands with a sterile towel and don a sterile gown and gloves. Category IB
• Clean underneath each fingernail prior to performing the first surgical scrub of the day. Category II
• Do not wear hand or arm jewelry. Category II
• No recommendation on wearing nail polish. Unresolved Issue

Management of infected or colonized surgical personnel

1. Educate and encourage surgical personnel who have signs and symptoms of a transmissible infectious illness to report conditions promptly to their supervisory and occupational health service personnel. Category IB
2. Develop well-defined policies concerning patient-care responsibilities when personnel have potentially transmissible infectious conditions. These policies should govern (a) Personnel responsibility in using the health service and reporting illness, (b) work restrictions, and (c) clearance to resume work after an illness that required work restriction. The policies also should identify persons who have the authority to remove personnel from duty. Category IB
3. Obtain appropriate cultures from, and exclude from duty, surgical personnel who have draining skin lesions until infection has been ruled out or personnel have received adequate therapy and infection has resolved. Category IB
4. Do not routinely exclude surgical personnel who are colonized with organisms such as S. aureus (nose, hands, or other body site) or group A Streptococcus, unless such personnel have been linked epidemiologically to dissemination of the organism in the healthcare setting. Category IB

Intraoperative Ventilation

• Maintain positive-pressure ventilation in the operating room with respect to the corridors and adjacent areas. Category IB
  
• Maintain a minimum of 15 air changes per hour, of which at least 3 should be fresh air. Category IB
  
• Filter all air, recirculated and fresh, through the appropriate filters per the American Institute of Architects' recommendations (American Institute of Architects, 1996). Category IB
  
• Introduce all air at the ceiling, and exhaust near the floor. Category IB
  
• Do not use UV radiation in the operating room to prevent SSI. Category IB
  
• Keep operating room doors closed except as needed for passage of equipment, personnel, and the patient. Category IB
  
• Consider performing orthopedic implant operations in operating rooms supplied with ultraclean air. Category II
  
• Limit the number of personnel entering the operating room to necessary personnel. Category II