Challenge 2C HAI

Surgical Site Infections (SSI)

Executive Summary Checklist

In order to establish a program to reduce surgical site infections (SSIs) the following implementation plan will require the actionable steps. The following checklist was adapted from the core prevention strategies recommended by the CDC.1

  • Hospital governance and senior administrative leadership must champion efforts to raise awareness of the problem in their own institution, in order to prevent and safely manage SSIs.
  • Educate patients and families on SSI prevention.
  • Implement surveillance and metrics to measure patient outcomes. The results of this monitoring should be reviewed at periodic caregiver education sessions, such as “grand rounds.”

Pre-operative:

  • Administer antimicrobial prophylaxis in accordance with evidence-based standards and guidelines:2
    • Administer within 1 hour prior to incision (2 hours for vancomycin and fluoroquinolones)
    • Select appropriate agents on basis of:
      1. Surgical Procedure
      2. Most common SSI pathogens for the planned procedure
      3. Known allergies or drug reactions of each specific patient.
      4. Published recommendations
  • Do not remove hair at the operative site unless it will interfere with the operation.
  • Use appropriate antiseptic agent and technique for skin preparation.
  • Maintain immediate postoperative normothermia.
  • If appropriate, mechanically prepare patients for colorectal surgery by enema or cathartic agents. Administer non-absorbable oral antimicrobial agents in divided doses on the day before the operation.

Intraoperative:

  • Keep operating room (OR) doors closed during surgery except as needed for passage of equipment, personnel, and the patient.

Postoperative:

  • Protect primary closure incisions with sterile dressing for 24-48 hours post-op.
  • Discontinue antibiotics within 24 hours after the surgery end time (48 hours for cardiac patients), unless signs of infection are present.

Between the 2017 World Patient Safety, Science & Technology Summit and the 2017 Midyear Planning Meeting a workgroup comprised of experts representing administrators, clinicians, technologists and patient advocates will meet to update this APSS. If you are interested in joining this workgroup, please email us.

References
  1. CDC. SSI Toolkit. http://www.cdc.gov/HAI/pdfs/toolkits/SSI_toolkit021710SIBT_revised.pdf
  2. Bratzler DW, et al. Surgical Infections. March 2013;14(1):73-156.

Parent Challenge

  1. Challenge 2: Healthcare-associated Infections (HAIs)