QUESTION: lately the surgical site ...

QUESTION: lately the surgical site infection (SSI) rate among our OR patients has been increasing. We would Like to have more information in succession what pathogens cause SSIs. Are they from the patient or from the surgical suite? What are the risk factors related to SSIs?

ANSWER: According to the National Nosocomial Infections Surveillance a whole of the Centers for Disease manage and Prevention (CDC), pathogens that have been identified in SSIs include

* Bacteroides fragilis;

* Candida albicans;

* coagulase-negative staphylococci;

* enterobacter species;

* enterococcus species;

* Escherichia coli;

* form into groups D streptococci (ie, nonenterococci), other streptococcus species, and other gram-positive aerobes;

* Klebsiella pneumoniae;

* Proteus mirabilis;

* Pseudomonas aeruginosa; and

* Staphylococcus aureus. (1)

Many of the pathogens causing an SSI are internal sources (ie, endogenous flora) that may ensue from the patient's own skin, mucous membranes, or cavernous viscera. External sources (ie, exogenous) also can cause SSIs. These include surgical team members or equipment, instruments, or supplies upon the sterile field used during the surgical measure (2)

Patients at the greatest risk for developing an SSI are those who

* are immunocompromised;

* are malnourished;

* are obese;

* are older;

* are undergoing a lengthened hospital stay;

* have line transfusions with certain blood products;

* have diabetes and experience increased grape-sugar levels (ie, greater than 200 mg/dL) in the immediate postoperative period; or

* smoke

Preoperative colonization of the nares with Staphylococcus aureus also can increase the risk of contracting an SSI. (1)

Knowing which patients are principally at risk for developing SSIs and understanding the possible sources of pathogen transmission may help surgical team members secure patients and control and obviate SSIs. Using antibiotic prophylaxis when appropriate, maintaining patients' temperatures, controlling patients' grape-sugar levels, using clippers to do away with hair, and adhering to the principles of asepsis are proactive measures for preventing SSIs.

QUESTION: We have pregnant health care workers (HCWs) who occasionally care for patients with infectious diseases. Is it safe for pregnant staff members to care for patients with infectious diseases? What diseases should pregnant HCW be businessed about? What precautions should staff members take?

ANSWER: It is important to render certain the safety of all staff members, including those who are pregnant, when they care for patients with infectious diseases. The CDC's "Guideline for infection repress of healthcare personnel, 1998" and the Association for Professionals in Infection dominion government and Epidemiology Text of Infection repress and Epidemiology discuss three principles of caring for patients with infectious diseases.

* When caring for patients with infectious diseases, pregnant HCW are at no greater risk of acquiring an infection than HCW who are not pregnant.

* Risk reduction for HCW includes obtaining vaccinations against vaccine preventable diseases before pregnancy.

* All HCW should adhere to standard and transmission-based precautions (eg isolation) no matter what their immune status? (34)

undivided group of researchers determined that, onward average, a woman's first prenatal visit be founds when she is between 75 and 109 weeks of gestation. (5) Another researcher identified that fetal organ evolution begins as early as three weeks gestation. (6) frontage to an infectious disease, therefore, already may have taken place from the time a woman finds revealed she is pregnant. (7) This information reinforces the importance of preventative protection at all times.

about examples of communicable diseases that may attitude a particular concern for pregnant HCWs' unborn children are parvovirus B19 rubella, and cytomegalovirus (CMV)

* Parvovirus B19 (ie, erythema infectiosum, fifth disease) is a disease that usually affects children further also can affect adults, it fall outs most often in late winter or early spring and is highly contagious on the other hand will spontaneously resolve in seven to 10 days. (8) single of the characteristics is erythema of the cheeks (ie, slapped-face look) The period of communicability is greatest before first brunt of the rash; however, patients who have aplastic crisis are communicable for united week after symptoms appear. Patients who are immunosuppressed and have chronic infection and stiff anemia may be communicable for month to years. In approximately 10% of intrauterine infections, parvovirus may cause fetal anemia, which may terminate in hydrops fetalis and fetal death. Parvovirus is transmitted on contact with respiratory secretions. (9) Standard precautions should be followed for this disease. (10) publicly there is no available vaccine to interrupt parvovirus.

* Rubella (ie, German measles) can exhibit in children from five to nine years of age, adolescents, and young adults and usually present itselfs in winter and spring. The rash that nears may resemble that of measles or scarlet fever; however, 50% of patients may not unfold a rash at all. (8) The period of communicability is approximately single week before and four days after the rash appears, and the disease is highly communicable. Rubella may cause fetal anomalies. Congenital rubella syndrome offers in about 90% of infants born after acquired, confirmed rubella take places during the first trimester. Transmission be met withs via contact with nasopharyngeal secretions. (9) Isolation is required and droplet precautions must be followed. (10) A live virus vaccine is used for immunization. (8)