References

Bergström A, Dimopoulou M, Eldh M Reduction of surgical complications in dogs and cats by the use of a surgical safety checklist. Vet Surg. 2016; 45:(5)571-576 https://doi.org/10.1111/vsu.12482

Billas AR, Grimes JA, Hollenbeck DL, Dickerson VM, Wallace ML, Schmiedt CW Incidence of and risk factors for surgical site infection following canine limb amputation. Vet Surg. 2022; 51:(3)418-425 https://doi.org/10.1111/vsu.13762

Bowers L Aseptic skin preparation: reducing the risk of surgical site infection. The Veterinary Nurse. 2012; 3:(9)544-551 https://doi.org/10.12968/vetn.2012.3.9.544

Burgess BA Prevention and surveillance of surgical infections: a review. Vet Surg. 2019; 48:(3)284-290 https://doi.org/10.1111/vsu.13176

Cray MT, Selmic LE, McConnell BM Effect of implementation of a surgical safety checklist on perioperative and postoperative complications at an academic institution in North America. Vet Surg. 2018; 47:(8)1052-1065 https://doi.org/10.1111/vsu.12964

Daniels R, Nutbeam T, McNamara G, Galvin C The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study. Emerg Med J. 2011; 28:(6)507-512 https://doi.org/10.1136/emj.2010.095067

Espinel-Rupérez J, Martín-Ríos MD, Salazar V, Baquero-Artigao MR, Ortiz-Díez G Incidence of surgical site infection in dogs undergoing soft tissue surgery: risk factors and economic impact. Vet Rec Open. 2019; 6:(1) https://doi.org/10.1136/vetreco-2017-000233

Eugster S, Schawalder P, Gaschen F, Boerlin P A prospective study of postoperative surgical site infections in dogs and cats. Vet Surg. 2004; 33:(5)542-550 https://doi.org/10.1111/j.1532-950X.2004.04076.x

Garcia Stickney DN, Thieman Mankin KM The impact of postdischarge surveillance on surgical site infection diagnosis. Vet Surg. 2018; 47:(1)66-73 https://doi.org/10.1111/vsu.12738

Glenn OJ, Faux I, Pratschke KM, Bowlt Blacklock KL Evaluation of a client questionnaire at diagnosing surgical site infections in an active surveillance system. Vet Surg. 2024; 53:(1)184-193 https://doi.org/10.1111/vsu.14011

Horan TC, Andrus M, Dudeck MA CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008; 36:(5)309-332 https://doi.org/10.1016/j.ajic.2008.03.002

Jordan R Surveillence of hospital acquired infection in veterinary practices. The Veterinary Nurse. 2022; 13:(2)52-57

Khan M, Zarin M, Khalil J, Salman M Influence of ASA score and Charlson Comorbidity Index on the surgical site infection rates. J Coll Physicians Surg Pak. 2010; 20:(8)506-509

Lavallée JF, Gray TA, Dumville J, Russell W, Cullum N The effects of care bundles on patient outcomes: a systematic review and meta-analysis. Implement Sci. 2017; 12:(1) https://doi.org/10.1186/s13012-017-0670-0

Low D Pathway to zero surgical site infections. UK-Vet Equine. 2022; 6:(S6) https://doi.org/10.12968/ukve.2022.6.S1.2

Kawase K, Ujiie H, Takaki M, Yamashita K Clinical outcome of canine cardiopulmonary resuscitation following the RECOVER clinical guidelines at a Japanese nighttime animal hospital. J Vet Med Sci. 2018; 80:(3)518-525 https://doi.org/10.1292/jvms.17-0107

Kerrigan L Surgical skin preparation — are we just going around in circles?. The Veterinary Nurse. 2018; 9:(1)20-25 https://doi.org/10.12968/vetn.2018.9.1.20

Marchionatti E, Constant C, Steiner A Preoperative skin asepsis protocols using chlorhexidine versus povidone-iodine in veterinary surgery: A systematic review and meta-analysis. Vet Surg. 2022; 51:(5)744-752 https://doi.org/10.1111/vsu.13810

Nas J, Te Grotenhuis R, Bonnes JL Meta-analysis comparing cardiac arrest outcomes before and after resuscitation guideline updates. Am J Cardiol. 2020; 125:(4)618-629 https://doi.org/10.1016/j.amjcard.2019.11.007

National Healthcare Safety Network. Surgical site infection event. 2023. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf (accessed 14 June 2024)

Nelson LL Surgical site infections in small animal surgery. Vet Clin North Am Small Anim Pract. 2011; 41:(5)1041-viii https://doi.org/10.1016/j.cvsm.2011.05.010

O'Dwyer L Factors resulting in delayed wound healing. The Veterinary Nurse. 2012; 3:(2)80-87 https://doi.org/10.12968/vetn.2012.3.2.80

Papadopoulos A, Machairas N, Tsourouflis G Risk factors for surgical site infections in patients undergoing emergency surgery: a single-centre experience. In Vivo. 2021; 35:(6)3569-3574 https://doi.org/10.21873/invivo.12660

Rose N, Toews L, Pang DS A systematic review of clinical audit in companion animal veterinary medicine. BMC Vet Res. 2016; 12 https://doi.org/10.1186/s12917-016-0661-4

Ruple-Czerniak A, Aceto HW, Bender JB Using syndromic surveillance to estimate baseline rates for healthcare-associated infections in critical care units of small animal referral hospitals. J Vet Intern Med. 2013; 27:(6)1392-1399 https://doi.org/10.1111/jvim.12190

Stetter J, Boge GS, Grönlund U, Bergström A Risk factors for surgical site infection associated with clean surgical procedures in dogs. Res Vet Sci. 2021; 136:616-621 https://doi.org/10.1016/j.rvsc.2021.04.012

Thieman Mankin KM, Jeffery ND, Kerwin SC The impact of a surgical checklist on surgical outcomes in an academic institution. Vet Surg. 2021; 50:(4)848-857 https://doi.org/10.1111/vsu.13629

Turk R, Singh A, Weese JS Prospective surgical site infection surveillance in dogs. Vet Surg. 2015; 44:(1)2-8 https://doi.org/10.1111/j.1532-950X.2014.12267.x

The evidence for checklists and patient care bundles in veterinary nursing. 2022. https://todaysveterinarynurse.com/emergency-medicine-critical-care/the-evidence-for-checklists-and-patient-care-bundles-in-veterinary-nursing/ (accessed 14 June 2024)

Wolfhagen N, Boldingh QJJ, Boermeester MA, de Jonge SW Perioperative care bundles for the prevention of surgical-site infections: meta-analysis. Br J Surg. 2022; 109:(10)933-942 https://doi.org/10.1093/bjs/znac196

UK Sepsis Trust. The sepsis manual. 2022. https://sepsistrust.org/wp-content/uploads/2022/06/Sepsis-Manual-Sixth-Edition.pdf (accessed 14 June 2024)

Yin C, Sun L Risk factors contributing to postoperative surgical site infections in patients undergoing ankle fracture fixation: a systematic review and meta-analysis. Int Wound J. 2024; 21:(4) https://doi.org/10.1111/iwj.14639

Yon E How to reduce the risk of surgical site infections. The Veterinary Nurse. 2019; 10:(1)42-46 https://doi.org/10.12968/vetn.2019.10.1.42

Yon E, Welsh P, Morrin H The professional RVN. In: Badger S, Jeffery A (eds). 2022 https://doi.org/10.1002/9781119664369.ch3

Wound care

Care bundles to reduce surgical site infections and promote positive outcomes

02 June 2024
Features
02 June 2024
Volume 15 · Issue 5
Figure 1. Surgical site infection affecting a canine limb. Credit: Nancy McLaughlin.
Figure 1. Surgical site infection affecting a canine limb. Credit: Nancy McLaughlin.

Abstract

All surgical patients are at risk of surgical site infections which can cause serious wound healing complications. To improve patient care and promote good patient outcomes, veterinary nurses must be aware of the pathophysiology and clinical signs of surgical site infections, in addition to how to reduce the risks of surgical site infections in clinical practice. There are many evidence-based techniques that can be implemented to reduce the risk of surgical site infections; multiple techniques may be combined into a care bundle, a relatively novel concept in veterinary medicine. Individual practices should be aware of emerging techniques and implement care bundles that are most relevant to their surgical case load. This article discusses surgical site infections and considers the appropriateness and application of care bundles into veterinary practice through governance techniques.

This article will explore care bundles as a tool for reducing surgical site infections (SSIs). To achieve this, the impact of SSIs on patient outcomes will be considered and guidance will be provided on how to reduce their occurrence, specifically through an exploration of how care bundles can assist in this. The article aims to provide practical direction for implementing change and improving standards of patient care in relation to reducing SSIs.

SSIs affect large numbers of veterinary patients each year and are infections that occur at, or near, to the surgical site up to 30 days post surgery, or up to 1 year after implants have been placed (Horan et al, 2008). In human medicine, SSIs are classified based on a set of criteria defined by the National Healthcare Safety Network (2023) (see Table 1). Generally, the same principles are applied to SSIs observed in veterinary medicine.

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Infection
Surgical site infections
Wound care