Surgical Site Infection Prevention Bundle

Surgical Site Infection Prevention Bundle Fact Sheet: Surgical Care Improvement Project measures

The surgical site infection prevention bundle focuses on 4 care processes that have been shown to reduce the risk of surgical site infection.

1. Effective Antibiotic Prophylaxis:

 Appropriate antibiotic choice - Select the appropriate agent based on the likely organisms to cause an SSI for that particular type of operation. (Laminated posters listing appropriate antibiotics have been placed in every OR).

 Appropriate timing of initial dose - Achieve therapeutic levels of the antibiotic in both blood and tissues 60 minutes or less prior to incision

 Appropriate re-dosing - Maintain therapeutic levels of the antibiotic in both blood and tissues throughout the operation until the incision is closed. (The length of the procedure and estimated blood loss are factors that influence re-dosing schedule).

 Discontinuation within 48 hours of incision. – There is no added benefit and may cause resistance

2. Minimal Skin Trauma related to Hair Removal:

 Avoid hair removal – If hair is not in the way of the incision the hair should not be removed.

 If it is necessary to remove hair, the best approach is the use of electric clippers. The utilization of electric clippers causes less skin injury and has been shown to decrease the risk for SSI compared to shaving.

 Razors should be removed from the operating room. Razors cause dermal abrasions providing an increased opportunity for infection

3. Maintenance of Normothermia:

 Maintaining perioperative normothermia ( ≥ 36◦ C ) reduces the risk of surgical site infection

4. Glycemic Control:  Maintaining glycemic control with continuous insulin infusion (CII) can prevent hyperglycemia and has been shown to decrease the risk for SSI in cardiac patients.

References

1. Antibiotics:

MangramAJ, Horan TC, Pearson ML, et al. Guideline for Prevention of Surgical Site Infection, 1999 Infection Control and Hospital Epidemiology 1999;20: 250-278

Bratzler, Dale W. et al. (2005) Use of Antimicrobial Prophylaxis for Major Surgery Archives of Surgery, 140:174-182.

Manian FA, et al. Surgical site infections associated with methicillin-resistant Staphylococcus aureus: Do postoperative factors play a role? CID 2003, 36:863-

2. Hair removal:

Horgan, H., Piatt, J. (1997). Shaving of the Scalp May Increase the Rate of Infection in CSF Shunt Surgery. Pediatric Neurosurgery, 26, 180-184.

Olson, M., et al. (1996). Pre-operative Hair Removal With Clippers Does Not Increase Infection In Clean Surgical Wounds. Surgery, Gynecology & Obstetrics, 162, 181-182.

Ko, W. Effects of shaving methods and intraoperative irrigation on suppurative mediastinitis after bypass operations. Annals of Thoracic Surgery 1992;53:301

3. Normothermia:

Kurz, A,et al (1996). Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization, The New England Journal of Medicine, 334: 1209 – 15.

4. Glucose control:

Furnary, A. et. al (1999) Continuous Intravenous Insulin Infusion Reduces the Incidence of Deep Sternal Wound Infection in Diabetic Patients after Cardiac Surgical Procedures. Annals of Thoracic Surgery, 67: 352 – 62. Van Den Berghe, G., et al. (2001). Intensive Insulin Therapy in Critically Ill Patients. The New England Journal of Medicine, 345, 1359-1367.