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
...commendatio...
...1. Recommendations to Prevent Surg...
Essential Practic...
...adopted by all acute-care hospitals...
...imicrobial prophylaxis according to evi...
...tion of parenteral and oral antimi...
3.
...surgical patients with an anti-staphyloco...
...ical patients in other procedures a...
4.Use antiseptic-containing preoperative vagin...
...remove hair at the operative site unless th...
...se alcohol-containing preoperative skin p...
...s not requiring hypothermia, maintain nor...
...e impervious plastic wound protectors for gastroi...
...ntraoperative antiseptic wound lava...
....Control blood-glucose level during th...
....Use a checklist and/or bundle to ensure complianc...
...surveillance for SSI. (M)3305355...
...3.Increase the efficiency of surveillance...
...ing SSI rate feedback to surgical and...
...provide feedback to healthcare personnel...
...surgeons and perioperative personne...
...ents and their families about SSI preve...
...nt policies and practices to reduce the risk o...
...9.Observe and review operating room...
...itional Approache...
...nsidered for use in locations and/or hosp...
....Perform an SSI risk assessment. (L)3305...
...of negative pressure dressings in...
...rve and review practices in the preo...
...tic-impregnated sutures as a strategy to preve...
...Should Not be Considered a Routine Part of SSI...
...ly use vancomycin for antimicrobial prophylaxis....
...o not routinely delay surgery to prov...
...not routinely use antiseptic drape...
...es...
...elected Risk Factors for and Recommendations t...
...ntrinsic, patient-related (preopera...
...difiable
AgeNo formal recommendation. Relationship t...
...ory of radiationNo formal recommendation. Prior...
...of skin and soft-tissue infectionsNo for...
...odifiabl...
...olControl serum blood-glucose levels for all surg...
...crease dosing of prophylactic antimicrob...
...sationEncourage smoking cessation within...
...pressive medicationsAvoid immune-suppre...
HypoalbuminemiaNo formal recommendation....
...aureus nasal colonizationDecolonize patients with...
...reparation of patie...
...air removalDo not remove unless hair will inte...
...rative infectionsIdentify and treat infections...
...ive characteristi...
...cal scrub (surgical team members’ hands and fo...
...eparationWash and clean skin around incision...
...ntimicrobial prophylaxisAdminister on...
...ood transfusionBlood transfusions increase th...
...l/techniqueHandle tissue carefully and...
...riate glovingAll members of the operative team sh...
...dhere to standard principles of op...
...imeNo formal recommendation. Minimiz...
...ng room characteristics...
...ntilationFollow ANSI/ASHRAE/ASHE Standard...
...rafficMinimize operating room traffi...
...surfacesUse an Environmental Protection Agency...
...terilization of surgical equipmentSterili...
...rs for Disease Control and Prevention’s Nationa...
...Prevention Internal Reporting Process and Out...
...ing Process Measure Example: Compliance...
...rnal Reporting Outcome Measure Example:...
...SI Prevention External Reporting Out...
...eral Requirementsa Reported via CDC NHS...
...ts and Collaboratives In states wi...
...Fundamental Elements of Accountabilit...