Preventing and Treating Surgical Site Infections

Although the US rate for surgical site infections in clean surgery is 2-3%, an estimated 40% to 60% of these are considered preventable.

Decreasing or eliminating patient activities and conditions such as nicotine use, obesity and malnutrition help reduce the risk of surgical site infections.

Other risk factors pertain to the surgical team and can be reduced by:

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

Guidelines recommended by the Center for Disease Control and Prevention, and a number of clinical studies, outline the current methods that will reduce the risk of, or prevent the development of surgical site infections.

Consult with Patients Before Surgery

It is recommended that patients receive clear and consistent information and advice about the risks of surgical site infections, prevention methods and treatment options.

Prepare Skin at the Surgical Site

It is also recommended the patient's skin be prepared at the surgical site before incision, using an antiseptic (aqueous or alcohol-based) preparation.

In analyses of contamination rates after a cholecystectomy, the main source of wound contamination was found to be the patient's skin.

Evidence has shown that the use of a preoperative wash containing chlorhexidine reduces skin's bacterial count by 80 to 90%, resulting in a decrease in preoperative wound contamination.

The effect on surgical site infection incidence has, however, been more difficult to demonstrate, and it is possible that prolonged washing releases organisms from deeper layers of the skin.

Avoid Shaving Patients Where Possible

It is now recognized that shaving damages the skin and increases the risk of infection depending on the length of time between the shaving and the 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 for infections, including surgical site infections.

Studies have also demonstrated that the risk of surgical site infections is correlated with the degree of glucose elevation in patients who do not have a history of diabetes.

Strict glucose control can decrease the rate of surgical site infection. This requires a concerted, coordinated effort by anesthesia, surgery and nursing:

The anesthesiologist must be ready to check the patient's focal glomerular sclerosis preoperatively and implement insulin therapy as early as indicated.
The surgeon must be prepared to continue the glucose control for at least 48 hours after surgery.
The nursing staff must take special care to monitor, calibrate and finely control normoglycemia during the inpatient stay.
- The nursing staff also needs to educate patients on the potential need for post-discharge glycemic control, especially if the 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.

Heat loss during the first hour of anesthesia is typically a result of the redistribution of core to peripheral temperature gradients caused by an anesthetic-induced decrease in vasoconstriction.

Actively pre-warming patients for two hours before the induction of either general or regional anesthesia can attenuate this effect.

The two most important causes of continued heat loss in the operating room are radiation and convection.

The most effective means of preventing these causes of ongoing losses are forced air warming and the administration of warmed fluids.

Provide Supplemental Perioperative Oxygen Therapy

Maintain optimal oxygenation by giving 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 randomized controlled trial, double blinded among 500 colorectal surgery patients, those who received 80% inspired oxygen during and up to two hours after surgery had a lower incidence of surgical site infection than those patients who received 30% inspired oxygen.

Use Prophylactic Antibiotics Appropriately

An estimated 40 to 60% of surgical site infections are preventable with appropriate use of prophylactic antibiotics.

Overuse, under use, improper timing, and misuse of antibiotics occur in 25 to 50% of operations.

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.

Use Antimicrobial Agents Appropriately

The chosen drug should be active against the pathogens most commonly associated with wound infections following a specific procedure and against the pathogens endogenous to the region of the body being operated on.

Time Antimicrobial Administration

To ensure the effective administration of the drug, it is recommended that:

The infusion of the antibiotic be timed to allow optimal concentration in the serum/tissue at the time of the incision and to maintain levels throughout the operation.
If the operation is longer than the half-life of the drug, the drug should be re-dosed during the procedure.
Discontinue the antibiotic within 24 hours after surgery.

Use of the surgical prophylaxis antimicrobial agent beyond this time frame has not been shown to improve surgical site infection rates and increases the cost of care unnecessarily. Indiscriminate use of antimicrobials can lead to the development of antibiotic-resistant microorganisms.

Prophylactic antibiotics use 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?

Follow the link to learn more about our breakthrough medical device, Collatamp G.

About Surgical Site Infections