Prevention and Treatment of Surgical Site Infections

Elizabeth A. Rice, MD,* and Thomas R. Talbot, MD, MPH

SUMMARY
Surgical site infections (SSIs) are a major cause of postoperative illness, longer hospitalization, and increased healthcare costs, making the prevention and treatment of SSIs an important aspect of patient care for hospitalists. The following module outlines the different patient and procedural risk factors that influence SSIs, examines the basic principles of antimicrobial prophylaxis for SSI, reviews nonantibiotic interventions to lessen the risk of SSI, and outlines evaluation for and treatment of an SSI. In addition, a discussion of the controversy surrounding preoperative decolonization of Staphylococcus aureus is provided. 
 
GOAL
To provide hospitalists with best practices to optimally prevent and treat surgical site infections.
 
TARGET AUDIENCE
This activity is designed for hospitalists. 
 
LEARNING OBJECTIVES
After completing the module, the participant should be able to:
 
  • IDENTIFY patient- and procedure-associated risk factors for the development of surgical site infections (SSIs).
  • DISCUSS the basic principles of antimicrobial prophylaxis for SSI, including aspects of drug selection, timing of administration, and the need for intraoperative redosing during prolonged surgical cases.
  • DESCRIBE nonantibiotic interventions designed to reduce a patient’s risk of developing SSIs, including prevention of hypothermia, reduction of hyperglycemia, and appropriate hair removal practices.
  • EVALUATE the controversy surrounding preoperative decolonization of Staphylococcus aureus.
  • DEVELOP an approach to the assessment and treatment of a patient with a possible SSI. 
CME INFORMATION
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of University of Virginia School of Medicine, ASiM, and the Society of Hospital Medicine. The University of Virginia School of Medicine is accredited by the ACCME to provide continuing medical education for physicians. 
 
The University of Virginia School of Medicine designates this enduring material, journal-based CME activity, test item writing activity for a maximum of 2.0 AMA PRA Category 1 Credits.TM Physicians should claim only the credit commensurate with the extent of their participation in the activity.   
 
Release date: June 27, 2016            Expiration date: June 27, 2019
 
Estimated time to complete activity: 2 hours 
 
FACULTY & FACULTY DISCLOSURES
Full Disclosure Policy Affecting CME Activities:
 
The University of Virginia School of Medicine, as an ACCME accredited provider, endorses and strives to comply with the Accreditation Council for Continuing Medical Education (ACCME) Standards of Commercial Support, Commonwealth of Virginia statutes, University of Virginia policies and procedures, and associated federal and private regulations and guidelines on the need for disclosure and monitoring of proprietary and financial interests that may affect the scientific integrity and balance of content delivered in continuing medical education activities under our auspices.
 
The University of Virginia School of Medicine requires that all CME activities accredited through this institution be developed independently and be scientifically rigorous, balanced and objective in the presentation/discussion of its content, theories and practices.
 
All faculty presenters participating in an accredited CME activity are expected to disclose relevant financial relationships with commercial entities occurring within the past 12 months (such as grants or research support, employee, consultant, stock holder, member of speakers bureau, etc.). The University of Virginia School of Medicine will employ appropriate mechanisms to resolve potential conflicts of interest to maintain the standards of fair and balanced education to the participant. Questions about specific strategies can be directed to the Office of Continuing Medical Education, University of Virginia School of Medicine, Charlottesville, Virginia.
 
The faculty and staff of the University of Virginia Office of Continuing Medical Education and ASiM have no financial affiliations to disclose.
 
The following relationships have been reported for this activity:
 
Leonard Feldman, MD, FACP, SFHM (Chair)
Associate Professor of Medicine
Johns Hopkins University School of Medicine 
Med-Peds Urban Health Residency Program Director
Associate Program Director, Osler Medical Residency
Director, Comprehensive General Medicine Consult Service
Editor, Consultative, and Perioperative Medicine Essentials for Hospitalists
Baltimore, Maryland
Dr Feldman reports having no significant financial or advisory relationships with corporate organizations related to this activity. 
 
Elizabeth A. Rice, MD, SFHM 
Assistant Professor of Medicine
Vanderbilt University Medical Center
Nashville, Tennessee
Dr Rice reports holding stock in Eli Lilly and Company. 
 
Thomas R. Talbot, MD, MPH
Associate Professor of Medicine and Health Policy
Vanderbilt University School of Medicine
Chief Hospital Epidemiologist
Vanderbilt University Medical Center
Nashville, Tennessee
Dr Talbot reports serving on the advisory committee/board for Novartis; and reports that his spouse reports receiving grants/research support from Gilead, MedImmune, and Sanofi Pasteur. 
 
Chris Arnold, MD (Peer Reviewer)
Assistant Professor 
Division of Infectious Diseases and International Health
University of Virginia Health System 
Charlottesville, Virginia
Dr Arnold reports receiving grants/research support for RSV treatment as part of a multicenter trial from Alios BioPharma Inc.
 
Disclosure of Discussion of Non-FDA–Approved Uses for Pharmaceutical Products and/or Medical Devices
 
The University of Virginia School of Medicine, as an ACCME provider, requires that all faculty presenters identify and disclose any off-label uses for pharmaceutical and medical device products. The University of Virginia School of Medicine recommends that each physician fully review all the available data on new products or procedures prior to clinical use.
DISCLAIMER
The opinions and recommendations expressed by faculty and other experts are based on current scientific evidence and standards of care and their professional expertise. This enduring material is produced for educational purposes only.  The University of Virginia School of Medicine implements specific educational planning processes to ensure that content is patient-centric and independent. The University of Virginia School of Medicine recommends that each physician fully review all the available data on new products or procedures prior to clinical use.
 
Click here to download the references for this educational activity.
 
The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: a nondesginated pre-test, a study program, and a CME post-test. All 3 sections must be completed to receive CME credit.
 
Supported by an educational grant from Merck & Co, Inc.
Course summary
Available credit: 
  • 2.00 AMA PRA Category 1 Credit™
  • 2.00 Participation (non-CME)
Course opens: 
06/27/2016
Course expires: 
06/27/2019
Non-member cost:
$0.00
Parent activity set: 
Rating: 
0

Available Credit

  • 2.00 AMA PRA Category 1 Credit™
  • 2.00 Participation (non-CME)

Accreditation Period

Course opens: 
06/27/2016
Course expires: 
06/27/2019

Price

Non-member cost:
$0.00
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