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 Infecti...
...ntial Practices...
...uld be adopted by all acute-care ho...
...er antimicrobial prophylaxis accordin...
...ion of parenteral and oral antimicrobial prophyl...
3.
...ze surgical patients with an anti-staphyl...
...e surgical patients in other procedures...
...antiseptic-containing preoperative vaginal prepa...
...ot remove hair at the operative site unles...
....Use alcohol-containing preoperative skin prepa...
...procedures not requiring hypothermia, maintain nor...
...impervious plastic wound protectors for ga...
...traoperative antiseptic wound lavage. (M...
...blood-glucose level during the immediate posto...
...a checklist and/or bundle to ensure compl...
...m surveillance for SSI. (M)330...
...he efficiency of surveillance by utilizing automat...
....Provide ongoing SSI rate feedback...
...easure and provide feedback to health...
...surgeons and perioperative personne...
...e patients and their families about SSI preven...
...Implement policies and practices to...
...review operating room personnel and the env...
...ditional Approaches...
Can be considered for use in locations and/or hos...
...erform an SSI risk assessment....
...use of negative pressure dressings in patients wh...
...erve and review practices in the preo...
4.Use antiseptic-impregnated sutures as a strat...
...s that Should Not be Considered a Routine P...
...not routinely use vancomycin for antimicrobial p...
...Do not routinely delay surgery to provide par...
...inely use antiseptic drapes as a strategy to p...
...ues...
...lected Risk Factors for and Recommendations to Pre...
...c, patient-related (preoperative...
...difiable...
...commendation. Relationship to increased...
...radiationNo formal recommendation. Prior irr...
...ry of skin and soft-tissue infectionsN...
...difiable...
...ucose controlControl serum blood-gl...
...se dosing of prophylactic antimicrobial...
...ssationEncourage smoking cessation within 30 d...
...ve medicationsAvoid immune-suppressiv...
...o formal recommendation. Though a noted risk fac...
...aureus nasal colonizationDecolonize patient...
...ration of patient...
Hair removalDo not remove unless hair will...
...infectionsIdentify and treat infection...
...tive characteristic...
...rub (surgical team members’ hand...
...in preparationWash and clean skin around...
...timicrobial prophylaxisAdminister only when in...
...onBlood transfusions increase the risk of SSI...
...on skill/techniqueHandle tissue carefully and er...
...vingAll members of the operative t...
...to standard principles of operatin...
...imeNo formal recommendation. Minimize as...
...g room characteristics...
...tionFollow ANSI/ASHRAE/ASHE Standa...
...ficMinimize operating room traffic. (L)3305355...
...ironmental surfacesUse an Environment...
...of surgical equipmentSterilize all surgical equipm...
...enters for Disease Control and Prev...
.... SSI Prevention Internal Reportin...
Internal Reporting Process Measure Example: Comp...
...ernal Reporting Outcome Measure Exam...
.... SSI Prevention External Reporting Outcome Mea...
...ementsa Reported via CDC NHSN in...
...tate Requirements and Collaboratives In states...
...e 5. Fundamental Elements of Accountability and...