Tag Archives: surgery

Meet Dr. Farrugia Fellowship Trained Breast Surgeon

Discontinuation of Anticoagulants Prior to Surgery

Anticoagulants. Discontinuation Prior to Surgery 042915

Surgeon scorecards

Individual surgeon scorecards have now been published by CMS. The link is now available from the “links” menu on this site for from here.

Finding Visit ID’s for Pre-Registered Patients

Finding Visit ID’s for patients that are pre-registered for a procedure, study, or surgery can be done in 2 quick steps.

While inside your census (My Patients or Group & My Patients) switch the Bed Filter and the Pt. Type to ALL and click search.

Preop1

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Your census list will be expanded to show “Pre-Reg” patients. Pre-Reg patients are patients that have been pre-registered for imaging studies, procedures, or surgery. The Visit ID will show up in the same place as the admit patients.

Preop2

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Please remember to use the Visit ID when dictating.

For questions or concerns, please contact Michael Millare or Prapti Desai at (815)759-4330.

Changes to reporting of SSI to CDC

The following information will be added to the current report to CDC/NHSN

  • Patient height, weight, and diabetes status will be reported for all procedures.
  • Operative duration, NHSN will adopt the Association of Anesthesia Clinical Directors definitions of Procedure/Surgery Start Time (PST), and Procedure/Surgery Finish.
  • NHSN is broadening its definition of an operative procedure to include those procedures that were not closed primarily. The closure type will be recorded for all procedures as either primarily closed or non-primarily closed, and this information will be used for risk adjustment purposes. NHSN has closely adapted the American College of Surgeons, NSQIP definition of primary closure.
    • Primary Closure is defined as closure of all tissue levels during the original surgery, regardless of the presence of wires, wicks, drains, or other devices or objects extruding through the incision. This category includes surgeries where the skin is closed by some means, including incisions that are described as being “loosely closed” at the skin level. Thus, if any portion of the incision is closed at the skin level, by any manner, a designation of primary closure should be assigned to the surgery.
    • Non-primary Closure is defined as closure that is other than primary and includes surgeries in which the superficial layers are left completely open during the original surgery and therefore cannot be classified as having primary closure. For surgeries with non-primary closure, the deep tissue layers may be closed by some means (with the superficial layers left open), or the deep and superficial layers may both be left completely open.
  • Hip arthroplasy (HPRO) and Knee arthoroplasty (KPRO): additional detail about procedures; total, hemi, and resurfacing (HPRO only) will be collected.
  • NHSN will adopt the Muscular Skeletal Infection Society’s (MSIS) Definition of Periprosthetic Joint Infection as a new organ/space infection site, SSI-PJI, which will replace SSI-JNT for HPRO and KPRO procedures.

Definition of Periprosthetic Joint Infection (PJI)

Joint or bursa infections must meet at least 1 of the following criteria:

  1. Two positive periprosthetic (tissue or fluid) cultures with identical organisms
  2. A sinus tract communicating with the joint
  3. Having three of the following minor criteria:
    1. Elevated serum C-reactive protein (CRP; >100 mg/L) AND erythrocyte sedimentation rate (ESR; >30 mm/hr).
    2. Elevated synovial fluid white blood cell (WBC; >10,000 cells/μL) count OR ++ (or greater) change on leukocyte esterase test strip of synovial fluid.
    3. Elevated synovial fluid polymorphonuclear neutrophil percentage (PMN% >90%).
    4. Positive histological analysis of periprosthetic tissue (>5 neutrophils (PMNs) per high power field).
    5. A single positive periprosthetic (tissue or fluid) culture.

Chlorhexidine: Usage manual

Chlorhexidine

It is a topical (external use) antiseptic to reduce bacteria (germs) on the skin. Its use can reduce risk of skin infections.

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Surgical Associates of Fox Valley joins Centegra Physician Care

We are delighted to inform you that Surgical Associates of Fox Valley has agreed to join Centegra Physician Care. This acquisition, which will be effective Oct. 1, 2013, is consistent with Centegra’s goal of strategic growth through the addition of top-quality medical practices and providers.

Surgical Associates of Fox Valley, located in Crystal Lake, has served our community since 1983. The group’s five surgeons have built their practice on general surgery; however they also offer the specialties of vascular, bariatric, oncologic and robotic surgery. Surgical Associates of Fox Valley includes Drs. Richard Lind, Amir Heydari, Aaron T. Schwaab, Eugene Lee and Alexandra Roginsky.

The integration of Surgical Associates of Fox Valley into CPC demonstrates Centegra’s continued commitment to providing comprehensive, high-quality healthcare to the residents of greater McHenry County and northern Kane County. We will continue to utilize Centegra’s full continuum of healthcare services as we work together to improve the lives of the patients we serve.

CPC, with the addition of Surgical Associates of Fox Valley, grows our provider team to 151 providers at 13 practice locations. The new name will be Centegra Physician Care-Surgical Associates.

Associates from both Centegra Physician Care and Surgical Associates of Fox Valley will continue to work closely together to ensure a smooth transition. Please join us in welcoming Surgical Associates of Fox Valley to Centegra Physician Care.

Jason Sciarro, President and Chief Operating Officer

Surgical care improvement project (SCIP)

  • Prophylactic antibiotic within 1 hour prior to incision
  • Prophylactic antibiotic selection
  • Antibiotic discontinued within 24 hours after Anesthesia end time
  • Cardiac Surgery Patients with Controlled 6 A.M. Postoperative Blood Glucose (< or = to 200mg/dl). (Hint: Use post op order set in Paragon- Order set list).
  • Perioperative Temperature Management (equal to or greater than 96.8 Fahrenheit/36 Celsius recorded within the 30 minutes immediately prior to or the 15 minutes immediately after Anesthesia End Time)
  • Urinary catheter removed on Postoperative Day 1 (POD 1) or Postoperative Day 2 (POD 2)
  • Surgery patients on Beta-Blocker therapy prior to arrival, who have received a Beta-Blocker during the perioperative period ( the day prior to surgery through POD 2 )
  • Venous Thromboembolism (VTE) Prophylaxis Order and administered within 24 hrs prior to or 24 hrs after surgery

Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery – 2013 update

Infectious Disease Society of America (IDSA) released update guidelines 1 for antimicrobial prophylaxis in surgery 2. Some of the key points in the update include:

  • The optimal for administration is now within 60 minutes prior to incision. This is more specific than the previous “induction of anesthesia” timing in the previous recommendations. Drugs like vancomycin should be administered within 120 minutes prior to incision.
  • Increased dosing for obese patients is now recommended. Use 3gm of cefazolin (Ancef) for patients weighing >120kg
  • Intraoperative redosing is recommended for procedures lasting more than two half lives of the drug. Redose cefazolin (Ancef) for procedures lasting greater than 4 hours (cefazolin half life is  2 hours). Time for re-administration should be measured from the first antibiotic dose and not the start of the procedure.
  • Duration of prophylaxis should be less than 24 hours for most procedures.
  • Routine use of vancomycin is not recommended for any procedure but should be considered for patients known to be colonized with MRSA or those at high risk for colonization is the absence of surveillance data.
  • The guidelines now have details for many specific surgical procedures.

 

SCIP antibiotic choices

Surgical procedure Approved antibiotics
Cardiac or Vascular Cefazolin, cefuroxime or vancomycin (see foot note) if allergy to beta lactam vancomycin or clindamycin
Hip or knee arthroplasty Cefazolin, cefuroxime or vancomycin (see foot note) if allergy to beta lactam vancomycin or clindamycin
Colon Cefotetan, Cefoxitin, Ampicillin/sulbactam OR [Cefazolin + Metronidazole], If β-lactam allergy: [Clindamycin + aminoglycoside], or [Clindamycin + Ciprofloxacin], or [Clindamycin + Aztreonam] or [Metronidazole with Gentamicin], or [Metronidazole + Ciprofloxacin]
Hysterectomy Cefotetan, Cefazolin, Cefoxitin, Cefuroxime or Ampicillin/sulbactam OR Clindamycin + ciprofloxacin OR Clindamycin + Aztreonam OR Metronidazole + Gentamicin OR Metronidazole + ciprofloxacin (CIPRO)

Notes

  • Vancomycin is acceptable with a physician/APN/PA/pharmacist documentation justification for its use (allergy to penicillin known MRSA, hospitalized >24 hrs; Cardiac valve surgery)
  • Levofloxacin 750mg may be substituted for Ciprofloxacin