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Overview and Implications

A Post Procedure infection is associated with a medical or surgical procedure and results from colonization with a bacterial load greater than the capability of the immune system to manage. These infections can significantly increase cost, morbidity and even mortality.
Surgical Site infections are most commonly caused by Staphylococcus, Streptococcus, and Pseudomonas bacteria. Any surgery that causes a break in the skin or mucosa can lead to a postoperative infection. Surgical site infections are a frequent cause of morbidity following surgical procedures. Surgical site infections have also been shown to increase mortality, readmission rates, length of stay, and costs for patients who incur them. In the United States, the rate of surgical site infection averages between two to three per cent for clean cases (Class I/Clean as defined by CDC), and an estimated 40 to 60 per cent of these infections are preventable. Surgical site infection is the most common healthcare associated infection among surgical patients, with 77 per cent of patient deaths reported to be related to infection (Cataife et al., 2014).


In Western countries, between two to five per cent of patients undergoing clean surgical procedures and up to 20 per cent of patients having intra-abdominal surgical procedures will develop a surgical site infection (Auerbach, 2011). Infected surgical patients are twice as likely to die, spend 60 per cent more time in the intensive care unit, and are five times more likely to be readmitted to hospital after initial discharge (Kirkland et al., 1999). Such infections result in 3.7 million extra hospital days and U.S. $1.6-3 billion in excess hospital costs per year (Kirkland et al., 1999 and Martone et al., 2001).


Knee and hip replacements are two of the most commonly performed surgeries in the United States, with more than 1.1 million combined cases performed annually. It is estimated that between 6,000 and 20,000 surgical site infections (SSIs) develop each year in the U.S. after knee and hip replacements, and these numbers are expected to rise (Hussaini, Martin, 2013).


Infective endocarditis (IE) is an infection of the endocardium, particularly affecting the heart valves, caused mainly by bacteria but occasionally by other infectious agents. IE can be caused by several different organisms, many of which could be transferred into the blood during an interventional procedure (Centre for Clinical Practice at NICE, 2008). IE often affects older patients who often develop IE as the result of healthcare-associated procedures. It can occur in patients with no previously known valve disease or in patients with prosthetic valves (Habib et al., 2009).


Endocarditis is a rare condition, with an annual incidence of fewer than 10 per 100,000 cases in the general population. Despite advances in diagnosis and treatment, IE remains a life-threatening disease with significant mortality (approximately 20 per cent) and morbidity (Centre for Clinical Practice at NICE, 2008).


Central Line-Associated Bloodstream Infections (CLABSIs): Central venous catheters (CVCs) are increasingly being used in both in- and out-patient settings to provide long-term venous access. CVCs disrupt the integrity of the skin, making infection with bacteria and/or fungi possible. This infection may spread to the bloodstream and cause hemodynamic changes and organ dysfunction (severe sepsis) to occur and, possibly lead to death. Approximately 90 per cent of the CLABSIs occur with CVCs. BSI may also occur in association with arterial catheters (Safer Healthcare Now! 2012).


Forty-eight per cent of intensive care unit (ICU) patients in the U.S. have central venous catheters, accounting for 15 million central-venous-catheter-days per year in U.S.-based ICUs. Studies of catheter-related bloodstream infections that control for the underlying severity of illness suggest that mortality attributable to these infections is between four per cent and 20 per cent. Thus, it is estimated that 500 to 4,000 US patients die annually due to bloodstream infections. Nosocomial bloodstream infections prolong hospitalization by a mean of seven days. Estimates of attributable cost per bloodstream infection are between U.S. $3,700 and $29,000. There are no equivalent Canadian figures for burden of illness (Safer Healthcare Now! 2012).

Goal

To prevent Post Procedural infections and deaths in hospitalized patients by reliably implementing evidence-based procedural care for all patients undergoing invasive procedures.