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
...ommendations...
Table 1. Recommendations to Prevent Surgical Sit...
Essential Practic...
...ed by all acute-care hospitals unl...
...minister antimicrobial prophylaxis accordin...
...Use a combination of parenteral and or...
3.
...surgical patients with an anti-staphyl...
...olonize surgical patients in other proce...
...se antiseptic-containing preoperative vaginal pre...
...t remove hair at the operative site unless...
...-containing preoperative skin preparatory agents...
...For procedures not requiring hypothermia, maintai...
...se impervious plastic wound protectors...
...intraoperative antiseptic wound lavage. (M)33...
...d-glucose level during the immediate...
...e a checklist and/or bundle to ensure complianc...
...orm surveillance for SSI. (M)3305355...
...he efficiency of surveillance by u...
...vide ongoing SSI rate feedback to surgical and...
...provide feedback to healthcare personnel (HCP)...
...surgeons and perioperative personnel about...
...ients and their families about SSI prevention as...
...8.Implement policies and practices to reduc...
...nd review operating room personnel and the enviro...
...dditional Approaches
Can be considered for use in locations and/o...
...m an SSI risk assessment. (L)3305355...
...nsider use of negative pressure dre...
...ve and review practices in the preoperat...
...Use antiseptic-impregnated sutures as a...
...hes that Should Not be Considered...
1.Do not routinely use vancomycin for antimicrobi...
...ely delay surgery to provide parenteral n...
...routinely use antiseptic drapes as a strategy to...
...sues Opt...
...e 2. Selected Risk Factors for and Rec...
...trinsic, patient-related (preoperative)
...modifiable
...commendation. Relationship to increased ris...
...y of radiationNo formal recommendation. Prior irr...
...skin and soft-tissue infectionsNo fo...
Modifiable
Glucose controlControl serum blood-glucose...
...esityIncrease dosing of prophylactic a...
...oking cessationEncourage smoking cessation with...
...sive medicationsAvoid immune-suppressiv...
...minemiaNo formal recommendation. Though a no...
...ureus nasal colonizationDecolonize...
...tion of patient...
...removalDo not remove unless hair will int...
...e infectionsIdentify and treat infections rem...
...perative characteristic...
...l scrub (surgical team members’ han...
...kin preparationWash and clean skin around incisio...
...prophylaxisAdminister only when i...
...sionBlood transfusions increase the risk of SSI...
...ill/techniqueHandle tissue carefully and eradicat...
Appropriate glovingAll members of the operative t...
...to standard principles of operating room aseps...
...perative timeNo formal recommendation. Minimi...
...room characteristics...
...ow ANSI/ASHRAE/ASHE Standard 170 recommend...
...ficMinimize operating room traffic. (L)33...
...ironmental surfacesUse an Environmenta...
...of surgical equipmentSterilize all s...
...ure 1. Centers for Disease Control and Prev...
...3. SSI Prevention Internal Reporting Proces...
...ernal Reporting Process Measure Example...
...porting Outcome Measure Example: Surgical Sit...
...revention External Reporting Outcome Measures...
...Requirementsa Reported via CDC NHSN in the Cente...
...tate Requirements and Collaborativ...
...mental Elements of Accountability and...