Strategies to Prevent Surgical Site Infections in Acute Care Hospitals
Key Points
Key Points
- In the preoperative setting, decolonize surgical patients with an anti-staphylococcal agent for cardiothoracic and orthopedic procedures.
- Consider decolonization for patients undergoing other procedures at high risk of staphylococcal surgical site infection (SSI), such as those involving prosthetic material.
- After a patient’s incision is closed, immediately discontinue antibiotics that were administered before and during surgery.
- No evidence supports continuing antibiotics after a patient’s incision has been closed prevents surgical site infections, even if the incision has drains.
- Continuing antibiotics increases the patient’s risk of C. difficile infection, acute kidney injury, and antimicrobial resistance.
- For patients undergoing elective surgery involving the colon, administer oral antibiotics in addition to parenteral (IV) antibiotics, rather than performing mechanical bowel preparation without oral antibiotics.
- Patients who get mechanical bowel preparation without oral antimicrobial agents have more complications.
- For patients undergoing cesarean delivery or hysterectomy, use antiseptic-containing preoperative vaginal preparation agents to reduce the risk of endometritis.
- Obtain a full allergy history.
- 10% of the population reports a penicillin allergy, but <1% of the population is truly allergic (CDC). Many patients with a self-reported penicillin allergy can safely receive the antibiotic as prophylaxis.
- Understand the nature of the patient’s listed allergy to avoid unnecessary use of less effective antibiotics to prevent SSIs.
- Do not routinely use vancomycin for antimicrobial prophylaxis.
- Reserve vancomycin for specific clinical situations (e.g., if a patient is known to be colonized with methicillin-resistant Staphylococcus aureus (MRSA), and especially if the patient’s surgery involves prosthetic material and/or will occur in the setting of an outbreak due to MRSA).
- For skin preparation prior to surgical incision, data from recent trials favor CHG-alcohol over povidone-iodine-alcohol.
- Perform antiseptic wound lavage intraoperatively. Ensure the sterility of the antiseptic used.
- Evidence does not support the use of saline lavage (non-antiseptic lavage).
- The authors recommend dilute povidone-iodine lavage rather than antibiotic irrigation.
- The use of supplemental oxygen for patients requiring mechanical ventilation is now an unresolved issue and no longer an essential practice.
- As an additional approach, consider the use of antiseptic-impregnated sutures at wound closure, particularly in colorectal surgery cases.
- In the OR and the post-acute care unit, during patients’ postoperative days 1-2 monitor and maintain blood glucose levels between 110-150 mg/dL in patients who are hyperglycemic, regardless of diabetes status.
- Postoperative blood glucose control that targets levels <110 mg/dL has been associated with a risk of significantly lowering the blood glucose level and increasing the risk of stroke or death.
- As an additional approach, consider the use of negative pressure dressings in the postoperative setting.
- The authors added negative pressure dressings as an additional approach, as some studies support their use in patients who have undergone abdominal surgery or joint arthroplasty.
- Evidence suggests that the benefit increases with age and body mass index.
- This pocket guide highlights practical recommendations to assist acute care hospitals in implementing and prioritizing SSI prevention efforts.
- It is based on a synthesis of evidence, theoretical rationale, current practices, practical considerations, author consensus, and consideration of potential harm, where applicable.
- No guideline or expert guidance document can anticipate all clinical situations. This pocket guide is not meant to be a substitute for individual clinical judgment by qualified professionals.
Recommendations
...mendations...
...Recommendations to Prevent Surgical Site Infectio...
...ntial Practices...
...d by all acute-care hospitals unless a...
1.Administer antimicrobial prophylaxis ac...
...bination of parenteral and oral an...
3.
...ize surgical patients with an anti-staphyloc...
...gical patients in other procedures...
...ntiseptic-containing preoperative vaginal p...
...ve hair at the operative site unless the...
...alcohol-containing preoperative skin preparatory...
...s not requiring hypothermia, maintain normother...
...plastic wound protectors for gastrointest...
...ntraoperative antiseptic wound lava...
....Control blood-glucose level during the...
11.Use a checklist and/or bundle to...
...urveillance for SSI. (M)3305355...
...se the efficiency of surveillance by utili...
14.Provide ongoing SSI rate feedback to sur...
...5.Measure and provide feedback to he...
...ucate surgeons and perioperative personnel about...
...7.Educate patients and their families...
...licies and practices to reduce the...
...Observe and review operating room perso...
...ional Approaches...
...considered for use in locations and/or hos...
...SSI risk assessment. (L)3305355...
...e of negative pressure dressings in pat...
...bserve and review practices in the...
...e antiseptic-impregnated sutures as a strategy...
...aches that Should Not be Considered a Rout...
...inely use vancomycin for antimicrobial prophylax...
...routinely delay surgery to provide parenter...
...outinely use antiseptic drapes as a st...
...sues...
...able 2. Selected Risk Factors for and Recomm...
...ntrinsic, patient-related (p...
...difiable...
...o formal recommendation. Relationship to incre...
...y of radiationNo formal recommendation...
...of skin and soft-tissue infectionsNo f...
...odifiable
...olControl serum blood-glucose levels for all surgi...
...ityIncrease dosing of prophylactic antimicrobial a...
...ng cessationEncourage smoking cessation within 3...
...unosuppressive medicationsAvoid immune-suppres...
...emiaNo formal recommendation. Though a note...
...aureus nasal colonizationDecolonize patients w...
...ation of patient...
...lDo not remove unless hair will int...
...eoperative infectionsIdentify and treat inf...
...tive characterist...
...scrub (surgical team members’ ha...
Skin preparationWash and clean skin arou...
...prophylaxisAdminister only when indicated....
...ionBlood transfusions increase the risk of SSI by...
...on skill/techniqueHandle tissue carefu...
...opriate glovingAll members of the opera...
...to standard principles of operating room as...
...ative timeNo formal recommendation. Minimize as...
...erating room characterist...
...low ANSI/ASHRAE/ASHE Standard 170 reco...
...afficMinimize operating room traffic. (L)330...
...l surfacesUse an Environmental Protection Agen...
...lization of surgical equipmentSterilize all...
...igure 1. Centers for Disease Control and Prev...
...3. SSI Prevention Internal Reporting...
Internal Reporting Process Measure Example: Comp...
...ternal Reporting Outcome Measure Example: Surgi...
.... SSI Prevention External Reporting Outco...
...Requirementsa Reported via CDC NHSN in the Cent...
...irements and Collaboratives In stat...
...mental Elements of Accountability and E...