Hygienic care of the Hygienic care of the patient before patient before surgerysurgery BARN 3rd Workshop, 1-2 October BARN 3rd Workshop, 1-2 October 2012, Sweden 2012, Sweden Hospital of Lithuanian University of Health Sciences

Kauno Klinikos

Institute of Hygiene

dr.G.Gailiene

Structure 21 buildings (area 123732,70

m2)

Number of profiled medical departments – 34

Subsidiaries – 4 (Oncology hospital, TB hospital, rehabilitation hospitals –child and adults)

Total number of beds (with subsidiaries)– 2605

Total number of staff – 6229

Number of surgical procedures

41049 4296947396

49419

5533858825 61120

65676

58282

0

10000

20000

30000

40000

50000

60000

70000

Procedures

2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

Prevalence of HCAI inPrevalence of HCAI inHospital of Lithuanian University of Health Hospital of Lithuanian University of Health Sciences Sciences Kauno KlinikosKauno Klinikos

27.830.9

34.6

10.3

20.3

25

31.4

25.8

35.8

23.2

10 5.57.6

7.4 4.5 4.75.7 6.1

5.7 6.856.6

2.7 3.4 1.5 1.6 1.83.8 3 4.4 3.3

0

5

10

15

20

25

30

35

40

2001 2002 2003 2004 2005 2006 2009 2010 2011 2012

%

ICU Surgery units Therapeutic units

Prevalence of HCAI according to site (%)in Hospital of Lithuanian University of Health Hospital of Lithuanian University of Health Sciences Sciences Kauno Klinikos 2012Kauno Klinikos 2012

Other, 2.8SST, 6.9

BSI, 2.8

GI_IAB, 4.2

SSI, 23.6

LRI, 45.8

UTI, 13.9

Prevalence of HCAI according to site in Lithuanian acute care hospitals (%)(Institute of Hygiene, 2010)

URI, 2.7SST, 15LRI, 12.7

Pneumonia, 16.7

UTI, 13.8

BSI, 5

Other, 16.7 SSI, 18.5

Prevalence of HCAI according to site in EU (%) (prevalence studies in EU counties 1990-2007)*

http://www.ecdc.europa.eu/en/publications/Publications/0706_SUR_Annual_Epidemiological_Report_2008.pdf

*

SSI, 17

BSI, 10.5

Other, 21.5 UTI, 27

LRI, 24

Recommendations/guidelines Patient preparation for surgery procedure:

Country – recommendations; Hospital – work instructions;

Methods

Cross-sectional studCross-sectional studies:ies: 2009 -140 patients;2009 -140 patients; 2012 – 66 patients2012 – 66 patients;;

Departments: 13 surgery (excluding ENT, eye); 2 ICU: general (medical/surgery), cardiology; 3 therapy: cardiology, gastroenterology,

nephrology.

Category IA - strongly recommended for implementation and supported by well- designed experimental, clinical, or epidemiological studies.

If hair is removed, remove immediately before the operation, preferably with electric clippers. Category IA

Hair Removal

0

10

20

30

40

50

60

70

2009 2012

55

68.2

14.3 12.8

22.1

05.7

1.52.9 4.5

Surgery day

Before surgery

Not removed

Day before surgery or earlier

Day before surgery at home

Method of hair removal

4.8

1.6

93.6

4.8

0

85.4

0 50 100

cutting

depilatory cream

shaving(machine/razor)

20122009

Electric clippers – 0.0 %

Category IB - strongly recommended for implementation and supported by some experimental, clinical, or epidemiological studies & strong theoretical rationale.

Require patients to shower or bathe with an antiseptic agent on at least the night before the operative day. Category IB

Patient shower or bath (PH -patient hygiene)

0

10

20

30

40

50

60

70

2009 2012

36.4

62 63.6

32

6

PH-day before surgery

No PH

PH-surgery day

PH-day before surgery at home

Changing of patient clothes and bed linen 2009:

• 9 patients were bathed night before surgery, clothes and bed linen changed on surgery day;

• 8 patients were bathed, bed linen wasn’t changed.

• For 2 patients bed linen was changed night before surgery, bathed on the surgery day;

• 1 patient wasn’t bathed, bed linen changed on surgery day.

Category II - Suggested for implementation and supported by suggestive clinical or epidemiological or theoretical rationale Keep preoperative hospital stay as short as

possible while allowing for adequate preoperative preparation of the patient. Category II

Preoperative hospital stay (days) 2009 - 1.2 (0.7 – 2.6) 2012 – 1.1 (0.6 – 3.1)

Category IA - strongly recommended for implementation and supported by well- designed experimental, clinical, or epidemiological studies. Administer by the intravenous route the

initial dose of prophylactic antimicrobial agent, timed such that a bactericidal concentration of the drug is established in serum and tissues when the incision is made... Category IA

In 2009 and 2012 – 100, 0% patients received antimicrobial agent i/v ≤ 1 - 0 h before incision.

Summary Decreased cases of hair removal night before

surgery (2009 - 5.7% vs. 2012 - 1.5%); Main method of hair removal remain shaving,

clippers are not used; In 2012 all patients were bathed and was

changed bed linen/clothes on surgery day; In general hygienic care of the patients

before surgery improved, but SSI rate does not decreased.

Thank you for attention