Course Access
Hi John,
Yes the world of SSIs are changing.
As the surgeon opened the wound and instituted a vac dressing ( a newer, slower and less invasive procedure than surgical debridement including a cleaner closure and surgical wound edge), I would classify go with a deep wound infection.
When we undertake SSI review on a daily basis: we look at several criteria including what other clinical symptoms did the they have including antibiotic treatment before the wound cultures were taken, have they used the correct technique in getting the specimen. Did the anti-thrombolytic agents contribute to the ooze?
John we have mainly implants i.e. joint replacements and we would use the criteria above to determine if they have a SSI. Many times there are no swabs or tissue samples or they are discarded and not sent, but the clinical picture, the invasive procedure and the treatment by the surgeon are all indicators of an SSI.
My thoughts.
Kind Regards
Marija Juraja |Clinical Service Coordinator (CICP) – Infection Prevention & Control Unit|
t: +61 8 8222 7588| p:47757| f: +61 8 8222 6461 | DX: 465432 |e:marija.juraja@health.sa.gov.au
Care Excellence Collaboration Integrity
GERMS CAN KILL…
Dear All
Would appreciate advice on interpretation of the definition (below)
In two sternotomy cases, there has been prolonged ooze post op (several days) and the surgeon concerned has opened the wound on the ward and then instituted vac dressings
The cases required prolonged nursing management but did not come to formal debridement or removal of sternal wires etc. CT scans did not show retrosternal collections (ie not organ space infection)
In my view, this constitutes a ‘deep’ wound infection. What would others say?
Our other surgeons would have usually taken such cases to theatre and performed open debridement
in one case the culture grew Serratia
in the other, culture was no growth; in that case, the determination rests then on whether we had ‘purulent drainage’ observed from the ‘deep incision’
it does beg the question as to how one gauges from what level the drainage is coming fron and also whether one should use an objective measure for what is purulent etc!
criterion b under superficial is also problematic – how does one ever get ‘aseptically-obtained’ samples from a superficial incision? wound swabs presumably not ok but I would guess are used
Would be very interested to know of how people teach surveillance staff to apply the NHSN definition, esp for sternotomies , where essentially the superficial wound is extremely close to the deep sternal structure , and also for prosthetic joints where similar problems of distinguishing the depth of infection arise
thanks
John
Dr John Ferguson
Director, Infection Prevention & Control, Hunter New England Health
Locked Bag 1, Newcastle Mail Centre, NSW 2310
Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 | john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org
[cid:image001.jpg@01CEB86A.85790C70]
[cid:image002.png@01CEB86A.85790C70][cid:image003.png@01CEB86A.85790C70]
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au