INFEKSI LUKA OPERASI

(SURGICAL SITE INFECTION) TINJAUAN ASPEK MANAJEMEN TEAM KAMAR OPERASI

RACHMAT ANDI HARTANTO

KEYWORDS DAN TERMINOLOGI

TEAM KAMAR OPERASI ( MANAJEMEN) INFECTION SURGICAL SITE INFECTIONS (SSI)

OPERATING ROOM MANAGEMENT

RONALD A. GABEL ET.AL (1999)

TEAM AND TEAM WORK : A GROUP OF PEOPLE WORKING TOGETHER FOR A COMMON GOAL REQUIRES A HIGH DEGREE OF COORDINATION TO BE EFFECTIVE, AND THIS COORDINATION REQUIRES VARIYING DEGREE OF COMMUNICATION

TEAM KAMAR OPERASI

THREE GROUPS OF PROFESIONALS 1. SURGEON 2. ANESTHESIOLOGIST 3. NURSES
-

MUST INTERACT HARMONIOUSLY IN THE OR ALL SUPPORTED BY A VARIETY OF SPECIALIZED TECHNICIANS AND OTHER PERSONNEL

NURSING SERVICE
1. NURSES ARE INVOLVED IN EVERY ASPECT OF OR FUNCTION FROM THE PREOPERATIVE CLINIC THROUGH POST OPERATIVE PERIOD

2. NURSES PREPARE PATIENTS FOR SURGERY, ASSIST IN

THE INDUCTION OF ANESTHESIA, PARTICIPATE IN THE PERFORMANCE OF THE SURGERY ITSELF, AND CARE FOR PATIENTS RECOVERING FROM ANESTHESIA AND SURGERY

THE FIRST RESPONSIBILITY OF PERIOPERATIVE OF TEAM OPERATING ROOM NURSING

PREPARE PATIENTS, OR, AND THE SUPPLIES AND EQUIPMENT PERFORMANCE OF NECESSARY FOR SAFE, EFFECTIVE AND EFFICIENT SURGERY

INNOVATIVE HEALTH CARE DELIVERY TEAMS

ANNEKE FITZERALD & GRAYDOW (JOURNAL OF HEALTH ORGANESATION AND MANAGEMENT, 2008)

LEARNING TO BE TEAM PLAYERS IS AS IMPORTANT AS LEARNING OTHER SPECIALISED SKILLS

SAFETY IN OPERATING THEATRES IMPROVING TEAMWORK THROUGH TEAM RESOURCE MANAGEMENT

ALAN BLEAKLEY ET AL ,2004 ( JOURNAL OF WORK PLACE LEARNING)

DYNAMIC AND POTENTIALLY HIGH RISK WORK ENVIRONMENTS SUCH AS OPERATING THEATRES ARE VULNERABLE TO MULTIPLE COMMUNICATIVE ERRORS

 WHILE TECHNOLOGIES, PHYSICAL DESIGN OF

WORKSPACE AND PROTOCOLS CAN COUNTER CERTAIN ERRORS, COHESIVE TEAMWORK IS A BOTTOM LINE FACTOR IN EFFECTIVE THEATRE PRACTICE LEADING TO GOOD PATIENT CARE AND SAFETY

WHERE TEAMWORK IS POOR, THIS MAY BE REMEDIABLE THROUGH EDUCATIONAL INTERVENTION

* INFECTION * SURGICAL SITE INFECTION

SURGICAL SITE INFECTION

DEFINITION : INFECTIONS OCCURING UP TO 30 DAYS AFTER SURGERY ( OR UP TO ONE YEAR IN PATIENTS RECEIVING IMPLANTS ) AND AFFECTING EITHER THE INCISION OR DEEP TISSUE AT THE OPERATION SITE
(C.D. OWENS, K. STOESSEL, 2008)

BACK GROUND & PROBLEMS

SSIs

ARE

ASSOCIATED

WITH

SUBSTANTIAL

MORBIDITY, MORTALITY AND COST

SSIs

THE

MOST

COMMON

AND

SERIOUS

COMPLICATIONS FOR PATIENTS WHO UNDERGO OPERATIVE PROCEDURE

SSIs ACCOUNT FOR 14% - 17% OF ALL HOSPITAL ACQUIRED INFECTION.

38% OF NOSOCOMIAL INFECTIONS IN SURGICAL PATIENTS

5% OF THE NEARLY 30 MILLION SURGERIES PERFORMED EACH YEAR.

SSIs ARE ASSOCIATED WITH SUBSTANTIAL CLINICAL AND ECONOMIC COST

TWICE AS LONG ARE MORE LIKELY TO REQUIRE AN ICU ADMISSION

6 TIMES HIGHER RATE OF READMISSIONS

SSIs MORTALITY

TWICE AS LIKELY TO DIE DURING THEIR HOSPITALIZATION

CLASSIFICATION OF SSIs

Classification of surgical site infections (SSIs) according to the Centers for Disease Control National Nasocomial Infections Surveillance (CDC NNIS) system. Reproduced with permission from Mangram et al.

RISK FACTOR OF SSIs

Surgical site infections: epidemiology, microbiology, and prevention

Patient-related and procedure-related factors that may influence the risk of surgical site infections (adapted from Mangram et al.[2]).

Patient-related

Procedure-related

Age Nutritional status Diabetes Smoking Obesity Coexistent infection at a remote body site Colonisation with micro-organisms

Duration of surgical scrub Skin antisepsis Preoperative shaving Preopertative skin preparation Duration of operation Antimicrobial prophylaxis Operating room ventilation

SSIs THE CAUSATIVE PATHOGENS

v

DEPEND ON THE TYPE OF SURGERY THE MOST COMMON - STAPHYLOCOCCUS AUREUS (MRSA) - COAGULASE NEGATIVE - ENTEROCOCCUS SP - E. Coli STAPHYLOCOCCI

C.D.Owens, K. Stoessel
Pathogens commonly associated with different surgical proccedures (adapted from Mangram et al.2)

Type of surgery

Common pathogens*

Placement of graft,prothesis or implant Cardiac Neurosurgery Breast Ophthalmic Orthopaedic Non-cardiothoracic Vascular Appendectomy Billiary tract Colorectal Gastroduodenal

Staphylococcus aureus; CoNS

S. aureus; CoNS S. aureus; CoNS S. aureus; CoNS S. aureus; CoNS; streptococci; Gram negative bacilli S. aureus; CoNS; Gram negative bacilli S. aureus; CoNS; Streptococcus pneumoniae; Gram negative bacilli S. aureus; CoNS Gram negative bacilli; anaerobes Gram negative bacilli; anaerobes Gram negative bacilli; anaerobes Gram negative bacilli; Streptococci; oropharyngeal anaerobes (e.g.

MANAGEMENT OF SSIs
NUMEROUS PATIENT RELATED AND PROCEDURE RELATED FACTORS INFLUENCE THE A RISK OF SSIs AND HENCE WITH PREVENTION REQUIRES BUNDLE APPROACH

SYSTEMATIC ATTENTION TO MULTIPLE RISK FACTORS, IN ORDER TO REDUCE RISK OF BACTERIAL CONTAMINATION, AND IMPROVE THE PATIENTS DEFENCES

THE CENTERS FOR DISEASE CONTROL AND PREVENTION GUIDE LINES FOR THE PREVENTION OF SSIs

THE IMPORTANCE OF GOOD PATIENT PREPARATION

ASEPTIC PRACTICE ATTENTION TO SURGICAL TECHNIQUE ANTIMICROBIAL PROPHYLAXIS EMERGING TECHNOLOGIES SUCH AS

Surgical site infections : epidemiology, microbiology, and prevention

PATHOLOBIOLOGY OF INFECTION (CONCLUSIONS)

REFERENCES
1.

Ronald A. Gobel. et al., (1999) OPERATING ROOM MANAGEMENT British Library Cataloguing in Publication Data

2.

C.D. Owen, K. Stoessel., (2008) :

5.

A.C.A. Clements, et al., (2007) Risk stratification for Surgical Site Infection in Australia : evaluation of the US National Nosocomial Infection Surveillance Risk Index. Journal of Hospital Infection

6.

Alan Bleakley, et al., (2004) : SAFETY IN OPERATING THEATRES. Improving teamwork through team resource management. Journal of Workplace Learning.

7.

Andrew N. Healey. Jonathan Benn., (2009) Teamwork enables remote surgical control and a new model for a surgical system emerges. Cogn Tech Work.

8.

Anneke Fitzgerald & Graydon Daxison ., (2008) INNOVATIVE HEALTH CARE DELIVERY TEAMS. Journal of Health Organisation and Management