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Preventing Surgical Site Infections

Many clinical studies, as well as guidelines from the Center for Disease Control and Prevention, outline a number of methods—that you've likely already implemented—to help eliminate 40 to 60% of preventable surgical site infections.

Consult with Your Patient Before Surgery

Before surgery, encourage your patient to decrease or eliminate activities and conditions that increase the risk of surgical site infections. For example:

Nicotine use
Obesity
Malnutrition

Inform your patient of the other risk factors that you and the surgical team will work to eliminate by:

Practicing proper surgical team hand preparation
Ventilating and sterilizing the operating room
Using appropriate surgical attire and drapes
Employing the best surgical techniques.

Prepare Skin at the Surgical Site

Prepare the skin at the surgical site before incision using an antiseptic (aqueous or alcohol-based) preparation; Povidone-iodine or chlorhexidine are most suitable.

Evidence has shown that chlorhexidine decreases the bacteria count on the skin by 80%, resulting in a decrease in surgical site infections.

Avoid Shaving Your Patient Where Possible

Research has shown that shaving damages the skin and increases the risk of infection, depending on the length of time it's performed before surgery.

In one study, patients who were shaved more than two hours before surgery had an infection rate of 2.3%

Patients whose body hair was clipped had a rate of 1.7%. And patients not clipped or shaved had a rate of 0.9%.

If shaving is necessary, use electric clippers with a single-use head on the day of surgery.

Control Hyperglycemia

It has been well established that patients with diabetes are at increased risk of infections, including surgical site infections.

Strict glucose control can decrease the rate of surgical site infections.

In such cases, the anesthesiologist must be ready implement insulin therapy and the surgeon must be prepared to continue the therapy for at least 48 hours after surgery.

You and your nursing staff must take special care to monitor, calibrate and finely control normoglycemia during the inpatient stay.

You will also need to educate your patient on the potential need for post-discharge glycemic control, especially if your patient was newly noted to be hyperglycemic preoperatively.

Control Patient's Normal Body Temperature

Medical literature suggests that patients have a decreased risk of surgical site infection if they are not allowed to become hypothermic during the perioperative period.

Pre-warm your patient with forced air warming and administration of warmed fluids for two hours before the induction of either general or regional anesthesia to avoid hypothermia.

Maintain Optimal Oxygenation

Give your patients sufficient oxygen during major surgery and in the recovery period to ensure that a hemoglobin saturation of more than 95% is maintained.

In a study involving 500 colorectal surgery patients, lower incidences of surgical site infections were reported when they received 80% inspired oxygen up to two hours after surgery.

Use Prophylactic Antibiotics Appropriately

A large number of hospitalized patients develop infections caused by Clostridium difficile, and 16% of these infections in surgical patients can be attributed to inappropriate prophylaxis use alone.

Overuse, underuse, improper timing and misuse of antibiotics occurs in 25 to 50% of operations.

To properly administer prophylactic antibiotics and drastically reduce infection rates, follow these guidelines:

Time antibiotic infusion to allow optimal concentration in the serum/tissue at the time of the incision, and maintain the level throughout the operation.
If the surgical procedure is longer than the half-life of the drug, re-dose the drug during the procedure.
Discontinue the antibiotic within 24 hours after surgery. Indiscriminate use of antimicrobials can lead to the development of antibiotic-resistant microorganisms.

Use of prophylactic antibiotics is not an attempt to sterilize tissues, but a critically timed adjunct to other surgical site infection prevention measures.

Are There Other Ways to Prevent Surgical Site Infections?

Eighty percent of post-surgical deaths occur in high-risk patients.

For patients at high risk of surgical site infection, additional precautions may be necessary, including the use of a new medical device that delivers high doses of antibiotics directly at the site of infection risk with no systemic effect.

This device, Collatamp G, delivers high dose antibiotic cover only where needed, when needed.

Follow the link to learn more about preventing surgical site infections with Collatamp G.

About Surgical Site Infections