Strategies to Prevent Surgical Site Infections in Acute-Care Hospitals

Publication Date: May 3, 2023
Last Updated: November 15, 2023

Recommendations

Table 1. Recommendations to Prevent Surgical Site Infections (SSIs)

Essential Practices

Should be adopted by all acute-care hospitals unless a clear and compelling rationale for an alternative approach is present
1.
Administer antimicrobial prophylaxis according to evidence-based standards and guidelines. (H)
3305355
2.
Use a combination of parenteral and oral antimicrobial prophylaxis prior to elective colorectal surgery to reduce the risk of SSI. (H)
3305355
3.
Decolonize surgical patients with an anti-staphylococcal agent in the preoperative setting for orthopedic and cardiothoracic procedures. (H)
3305355
Decolonize surgical patients in other procedures at high risk of staphylococcal SSI, such as those involving prosthetic material. (L)
3305355
4.
Use antiseptic-containing preoperative vaginal preparation agents for patients undergoing cesarean delivery or hysterectomy. (M)
3305355
5.
Do not remove hair at the operative site unless the presence of hair will interfere with the surgical procedure. (M)
3305355
6.
Use alcohol-containing preoperative skin preparatory agents in combination with an antiseptic. (H)
3305355
7.
For procedures not requiring hypothermia, maintain normothermia (temperature >35.5°C) during the perioperative period. (H)
3305355
8.
Use impervious plastic wound protectors for gastrointestinal and biliary tract surgery. (H)
3305355
9.
Perform intraoperative antiseptic wound lavage. (M)
3305355
10.
Control blood-glucose level during the immediate postoperative period for all patients. (H)
3305355
11.
Use a checklist and/or bundle to ensure compliance with best practices to improve surgical patient safety. (H)
3305355
12.
Perform surveillance for SSI. (M)
3305355
13.
Increase the efficiency of surveillance by utilizing automated data. (M)
3305355
14.
Provide ongoing SSI rate feedback to surgical and perioperative personnel and leadership. (M)
3305355
15.
Measure and provide feedback to healthcare personnel (HCP) regarding rates of compliance with process measures. (L)
3305355
16.
Educate surgeons and perioperative personnel about SSI prevention measures. (L)
3305355
17.
Educate patients and their families about SSI prevention as appropriate. (L)
3305355
18.
Implement policies and practices to reduce the risk of SSI for patients that align with applicable evidence-based standards, rules and regulations, and medical device manufacturer instructions for use. (M)
3305355
19.
Observe and review operating room personnel and the environment of care in the operating room and in central sterile reprocessing. (L)
3305355

Additional Approaches

Can be considered for use in locations and/or hospital patient populations when HAIs are not controlled after implementation of essential practices.
1.
Perform an SSI risk assessment. (L)
3305355
2.
Consider use of negative pressure dressings in patients who may benefit. (M)
3305355
3.
Observe and review practices in the preoperative clinic, postanesthesia care unit, surgical intensive care unit, and/or surgical ward. (M)
3305355
4.
Use antiseptic-impregnated sutures as a strategy to prevent SSI. (M)
3305355

Approaches that Should Not be Considered a Routine Part of SSI Prevention

1.
Do not routinely use vancomycin for antimicrobial prophylaxis. (M)
3305355
2.
Do not routinely delay surgery to provide parenteral nutrition. (H)
3305355
3.
Do not routinely use antiseptic drapes as a strategy to prevent SSI. (H)
3305355

Unresolved Issues

  1. Optimized tissue oxygenation at the incision site.
  2. Preoperative intranasal and pharyngeal chlorhexidine gluconate (CHG) treatment for patients undergoing cardiothoracic procedures.
  3. Use of gentamicin-collagen sponges.
  4. Use of antimicrobial powder.
  5. Use of surgical attire.

Overview

Title

Strategies to Prevent Surgical Site Infections in Acute-Care Hospitals

Authoring Organizations

Infectious Diseases Society of America

Society for Healthcare Epidemiology of America