Discharge Planning: Surgical Site Infections
Adapted from Discharge and Transitions — Diabetic Foot Infection by Michael Radzienda
Discharge planning is essential to continue to minimize the risk of developing SSIs and for the early detection and treatment of those that do occur.
The figure below illustrates potential failure modes for postoperative patients that increase their risk of a SSI postdischarge, as well as potential solutions for improving outcomes.
|
Failure Mode |
Strategy |
Hyperglycemia |
- Diabetic education (patient and family).
- Diabetic follow-up (PCP or endocrine).
- Simplify regimen.
- Demonstrate competence (have patient/family draw up/administer own insulin before discharge).
- Achieve glycemic control prior to discharge.
- Provide diabetic care supplies (strips, glucometer).
|
Wound follow-up |
- Patient/family education (see patient fact sheets from the IHI, SCIP, and SHEA).
- Clear discharge instructions of signs and symptoms of SSIs for the patient, family, and follow-up providers.
- Home care visits.
|
Consultant reconciliation |
- Follow-up appointments for surgery and PCP coordinated before discharge.
- Discharge plan sent to/discussed with all outpatient clinicians involved in care (not just PCP).
|
Health literacy |
- Use read-back techniques to demonstrate patient understanding of discharge instructions.
- Discharge instructions should be at a fourth-grade reading level in patient’s first language.
- Provide patient and family with contact information of the hospital team in case of postdischarge questions.
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Resources
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. The Hospital Infection Control Practices Advisory Committee Guideline for the Prevention of Surgical Site Infection 1999. Infection Control and Hospital Epidemiology. 1999;20:247–278. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/SSI.pdf, 2010.
Anderson DJ, Kaye KS, Classen D, et al. Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29(S1):S51–S61. Available at: http://www.journals.uchicago.edu/doi/full/10.1086/591064?cookieSet=1. Accessed January 5, 2010.
Darouiche RO, Wall MJ, Itani KMF, et al. Chlorhexidine-alcohol versus povidine-iodine for surgical-site antisepsis. N Engl J Med. 2010;362:18–26.
Bode LGM, Kluytmans JAJW, Wertheim HFL, et al. Preventing surgical site infections in nasal carriers of Staphylococcus aureus. N Engl J Med. 2009;362:9–17.
Bratzler DW: The surgical care improvement project; an overview. Available at: http://www.medqic.org.
NNIS definitions of health-care associated infections. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/nnis/NosInfDefinitions.pdf. Accessed January 5, 2010.
SHEA patient fact sheet. Available at: http://www.shea-online.org/Assets/files/patient%20guides/SSI.pdf. Accessed January 5, 2010.
IHI patient fact sheet. Available at: http://www.ihi.org/explore/SSI/Pages/default.aspx. Accessed January 5, 2010.
SCIP patient fact sheet. Available at: http://www.premierinc.com/safety/topics/scip/downloads/consumer-tips.pdf. Accessed January 5, 2010.
Gaynes RP, Culver DH, Horan TC, Edwards JR, Richards C, Tolson JS. Surgical site infection (SSI) rates in the United States, 1992–1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis. 2001;33:S69–S77. Available at: http://www.ncbi.nlm.nih.gov/pubmed/11486302?dopt=Abstract. Accessed January 5, 2010.
Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections. Clin Infect Dis. 2005;41:1373–1406. Available at: http://www.journals.uchicago.edu/doi/pdf/10.1086/497143. Accessed January 5, 2010.
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