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
...Recom...
...Table 1. Recommendatio...
...Essential Pract...
...e adopted by all acute-care hospitals...
...Administer antimicrobial prophylaxis accordi...
2.Use a combination of parenteral and oral antimic...
3.
...surgical patients with an anti-staphyloco...
...surgical patients in other procedures at hig...
....Use antiseptic-containing preoperative...
...e hair at the operative site unless the pres...
...e alcohol-containing preoperative skin pr...
...procedures not requiring hypothermia,...
...se impervious plastic wound protectors fo...
...raoperative antiseptic wound lavage. (M)33...
...ood-glucose level during the immediate postop...
...ecklist and/or bundle to ensure compli...
...urveillance for SSI. (M)3305355...
...e the efficiency of surveillance by utilizing...
...ngoing SSI rate feedback to surgical and...
...d provide feedback to healthcare personnel (HCP)...
...surgeons and perioperative personne...
...atients and their families about SSI prevention as...
...t policies and practices to reduce the risk of...
...nd review operating room personnel and the environ...
...Additional App...
...considered for use in locations and/or hospit...
...n SSI risk assessment. (L)3305355...
...Consider use of negative pressure dressings in p...
...serve and review practices in the preo...
...se antiseptic-impregnated sutures...
...Approaches that...
...ely use vancomycin for antimicrobial prophylaxi...
2.Do not routinely delay surgery to prov...
...ly use antiseptic drapes as a strategy to preve...
...Unresolved Issues Opt...
...Table 2. Sele...
...Intrinsic,...
...Unmodifiable...
...recommendation. Relationship to increas...
...ationNo formal recommendation. Prior i...
...and soft-tissue infectionsNo form...
...Modifia...
...rolControl serum blood-glucose levels for all s...
...dosing of prophylactic antimicrobial agent fo...
...moking cessationEncourage smoking cessati...
...pressive medicationsAvoid immune-suppres...
...aNo formal recommendation. Though a note...
...sal colonizationDecolonize patients with nasal m...
...Preparatio...
...ovalDo not remove unless hair will interfere with...
...operative infectionsIdentify and treat infect...
...Operative charac...
...(surgical team members’ hands and for...
...Wash and clean skin around incision site. Use a d...
...crobial prophylaxisAdminister only...
...ionBlood transfusions increase the risk of SSI by...
...rgeon skill/techniqueHandle tissue carefully and...
...e glovingAll members of the operative te...
...standard principles of operating room ase...
...timeNo formal recommendation. Minimize as...
...Operating room characte...
...tilationFollow ANSI/ASHRAE/ASHE Stan...
...rafficMinimize operating room traf...
...urfacesUse an Environmental Protection Agency (...
...f surgical equipmentSterilize all surg...
...1. Centers for Disease Control and Preventio...
...Table 3. SSI Prev...
...ternal Reporting Process Measure Example: Comp...
Internal Reporting Outcome Measure Ex...
...Table 4. SSI...
...l Requirementsa Reported via CDC NHSN in...
...equirements and Collaboratives I...
...ental Elements of Accountability and Eng...