Surgical Site Infections

This blueprint outlines the steps that frontline staff can follow to prevent Surgical Site Infections:

Symptoms of a surgical site infection (SSI) include redness and pain around the surgical site area, drainage of cloudy fluid from the surgical wound, and/or fever. Follow the steps identified below to prevent an SSI: 

1. Preoperative measures:
   1. Consider all minimally invasive measures first to make sure surgery is necessary.
   2. Conduct MRSA screening.
   3. Assess the patient for any allergies or sensitivities to skin antiseptics that may be used during the surgery.
   4. Provide clear and understandable instructions of the procedure to the patient and their family prior to surgery.
   5. Confirm patient identity, incision site, and procedure type.
   6. Remove patient jewelry or any clothing that may be an obstruction during the surgery.
   7. Isolate highly contaminated areas near the surgical site (e.g., anus).
   8. Utilize precautions to avoid ingestion of antiseptic for surgical sites near the mouth of the patient.
   9. Administer antibiotics within one hour prior to any surgical incisions and re-dose as needed per specific surgical procedure and patient.
2. Intraoperative measures:
   1. Closely monitor the patient’s vital signs during the procedure.
   2. When needed, utilize antibiotic-impregnated implants.
   3. Minimize blood transfusions.
   4. Minimize traffic inside the operating room.
   5. Maintain room humidity at 20%–60%.
   6. Keep the interior of the room at a positive pressure.
   7. Adhere to sterile precautions by enforcing strict hand scrub compliance and maintaining PPE for the entire procedure. Note: PPE is not to be taken or worn outside of the operating room.
   8. Maintain protection and cleanliness of the site during the entire operation and perform topical irrigation of the incision site.
   9. Maintain tight glucose and temperature control.
3. Postoperative measures:
   1. Ensure that all sponges, instruments, and needles used during the procedure are counted.
   2. Check blood glucose levels, temperature, and vital signs.
   3. Perform chlorhexidine shower two hours after the procedure.
   4. Protect primary closure incisions with sterile dressing for 24–48 hours post-op.
   5. Stop using antibiotics within 24 hours after the surgery end time—48 hours for cardiac patients, unless signs of infection are present.
   6. Document wound care and maintain infection vigilance during the entire stay of the patient at the hospital.
   7. Maintain infection vigilance throughout full hospital stay.
   8. If an infection is identified, actively engage the care team in sepsis prevention.
   9. Communicate key concerns for patient recovery with the full care team, including the patient and family.

Surgical site infection processes to consider assessing:

1. Use of the standard surgical safety checklist
2. Antimicrobial prophylaxis
3. Delivery of antibiotics
4. Documentation of wound care
5. Hair removal
6. Determination of the process/protocol that will be used for decolonization
7. Identification of surgical site infections
8. Discharge coordination
9. Use of blood transfusions
10. Set up of operating room conditions
11. Maintenance and sterilization of operating rooms
12. Fire risk assessment
13. Consideration of noninvasive alternatives
14. Sterile technique adherence
15. Procedural delays
16. Adaptation of procedure due to equipment or staffing shortages
17. Storage and disposal of antiseptics
18. Glucose and temperature control techniques intraoperatively and postoperatively

Risk Factors

Any patient undergoing a surgical procedure is at risk for an SSI. However, patient-specific risk factors include:

1. Pre-existing infection
2. Low serum albumin concentration
3. Old age
4. Obesity/diabetes
5. Smoking
6. Ischemia
7. Trauma
8. Blood transfusions
9. Hypothermia
10. Hypoxia
11. Hyperglycemia
12. Abdominal surgery