Best Practice Recommendations for the Prevention and ...

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24 TABLE 8 Categories of SSIs 2,3 SSIs can be divided into three categories (Table 8). In addition, SSIs can be acute (occurring within and lasting 38° C) or localized pain unless incision is culture negative; – Evidence of infection (e.g., abscess) involving deep tissue found during direct examination, during re-operation or by histopathologic or radiologic examination; or – Diagnosis of a deep incisional SSI by surgeon or attending physician. Category 3 Organ/space (involving any part of the body that does not include deep tissues, muscle or fascia, and that has been opened or manipulated during the surgical procedure); occurs within 30 days of operation if no implant, or within one year if implant in place. • Any part of body, excluding skin incision, fascia or muscle layers that is opened or manipulated during the operation. • At least one of: – Purulent drainage from a drain that is placed through a stab wound into the organ/space; – Organisms isolated from an aseptically obtained culture; or – Evidence of infection (e.g., abscess) involving organ/space found during direct examination, re-operation or by histopathologic or radiologic examination. • Diagnosis of an organ/space SSI by surgeon or attending physician. SSI = surgical site infection Mangram AJ, Horan TC, Pearson ML, et al. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20:250–78. Mangram AJ, Horan TC, Pearson ML, et al. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27:97–132. Wound Care Canada Volume 8, Number 1, 2010
the underlying surgical and non-surgical factors that have led to the infection. Further surgical intervention is frequently required, depending upon the surgical problem, usually to remove devitalized tissue or infected foreign material, close a fistula or ulcer space or drain/remove a sinus tract. Multiresistant microorganisms such as MRSA, other Gram-negative bacteria or even fungi may be involved. Long-term antibiotics are usually required, based on the antimicrobial susceptibility patterns of the isolated microflora. Rehabilitation is frequently needed as part of the recuperation phase. Recommendation 8: Provide optimal local wound moisture balance to promote healing by choosing an appropriate dressing for the acute and chronic phases of surgical wound healing (NICE level 1+; RNAO level IV). Moist wound healing is one of the cornerstones of evidence-based wound care in both the acute and chronic settings. 44–50 The advantages of moist wound healing include less intense and less prolonged inflammation; rapid keratinocytosis and increased fibroblast proliferation; an increased rate of collagen synthesis and epithelial cell migration, resulting in earlier angiogenesis; and faster contraction of fullthickness wounds. 45,46,49 Acute surgical wounds Acute wounds (including surgical wounds) are caused by external trauma to the human body and follow a systematic process of repair, progressing through vascular, inflammatory, proliferation and maturation stages of healing. 48,51 Wounds with minimal tissue loss that are closed surgically heal by primary intention when the closure joins the wound edges, eliminating dead space and continued on page 26 Volume 8, Number 1, 2010 Wound Care Canada 25
Page 1 and 2: Canadian Publication Mail Sales Pro
Page 3 and 4: Volume 8, Number 1, 2010 ISSN 1708-
Page 5 and 6: CAWC NEWS Canadian Association of W
Page 7 and 8: Prevention and Management of Open S
Page 9 and 10: When wounds fail to progress after
Page 11 and 12: PRESENTING FIRST STEP® ALL-IN-ONE
Page 13 and 14: specialized decision-making regardi
Page 15 and 16: affect interactions, including disa
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Page 20 and 21: 20 TABLE 5 MEASURE for wound assess
Page 22 and 23: 22 TABLE 6 Recognizing Unwanted Res
Page 26 and 27: 26 TABLE 9 Acute versus Chronic SSI
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Page 30 and 31: 30 Indications/benefits A post-oper
Page 32 and 33: 32 Indications/benefits The benefit
Page 34: 34 cal/structural, cognitive, psych
Page 37 and 38: organisationnel, ni les stratégies
Page 39 and 40: (p. ex., antiseptiques toxiques) ou
Page 41 and 42: des agents antimicrobiens topiques.
Page 43 and 44: *When compared to standard V.A.C.
Page 45 and 46: • fournir une réponse à ces fac
Page 47 and 48: nécrotiques lâches et de diluer l
Page 49 and 50: plus élevé incluent ceux qui pré
Page 51 and 52: laire. 48 Les plaies chroniques peu
Page 53 and 54: traitement est optimal. Si le rappr
Page 55 and 56: TABLEAU 10 Traitement des ISO aigu
Page 57 and 58: cellules épithéliales, promeut la
Page 59 and 60: Mise en garde Seul un médecin expe
Page 61 and 62: Nosocomial Infections Surveillance
Page 63 and 64: 29 th CAET Conference The Wonders o

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