Surgical Site Infection Prevention

Surgical site infections (SSIs) are infections that occur after surgery in the area of the body where the surgery was performed (Centers for Disease Control and Prevention [CDC], 2019). SSIs are one of the most common and costly healthcare-associated infections in the United States (Anderson & Sexton, 2020). Approximately 50% of all SSIs are preventable based on current evidence-based strategies. It is important that the entire perioperative team have knowledge of the following strategies to prevent SSIs.

SSIs may be superficial, involving only the skin or more critical involving deeper tissues, organs or implanted devices.

Symptoms of SSIs include (CDC, 2019):

• Redness and pain at or around the surgical site
• Cloudy drainage from the surgical wound
• Fever

Patient Preparation

• Prior to elective surgeries, identify and treat any existing infections; postpone elective procedures until current infections are resolved.
• Instruct patients to shower or bathe their full body with soap (antimicrobial or non-antimicrobial) or with an antiseptic agent the night before surgery.
• Preoperative skin cleansing with chlorhexidine-based preparations are more effective than povidone-based solutions (Anderson & Sexton, 2020).
• Only remove hair at or around the intended incision site if it will interfere with the procedure; when necessary, remove it immediately prior to the operation, using clippers. Avoid shaving hair with razors at the operative site as shaving is associated with a high risk for SSI.
• Advise patients to stop using tobacco at least 30 days prior to elective surgery; smoking is associated with an increased risk for SSI and other complications (Anderson & Sexton, 2020).
• Ensure that skin at or near the incision site is free of gross contamination prior to applying antiseptic skin preparations.
• Bowel preparation prior to colon surgery reduces SSI rates (Anderson & Sexton, 2020).

Perioperative Staff Preparation

• Perform antisepsis of hands (including under the nails) and forearms with an antiseptic agent immediately prior to the procedure, in accordance with manufacturer’s recommendation for the specific product in use.
• Ensure all staff wear a surgical mask that fully covers the mouth and nose when they are present in the operating room, at any time when sterile instruments are exposed, when surgery is about to begin or in progress, and for the duration of the procedure.
• Wear a new, disposable, or hospital-laundered head covering for each case and ensure it fully encases all hair on the head and all facial hair not covered by a surgical mask.
• Every member of the scrubbed surgical team should wear sterile gloves, donned after the sterile gown is in place.
• Use only surgical gowns and drapes that are water resistant.
• Change scrubs if they become visibly soiled, contaminated, or are penetrated by blood or other infectious materials as soon as possible. Scrubs should not be worn during patient encounters outside the operating room or outside the hospital perimeter (Anderson & Sexton, 2020).
• Remove or cover all head and neck jewelry.

Operating Room & Surgical Instruments

• Maintain positive pressure ventilation in the operating room and adjoining spaces.
• Sterilize all surgical instruments according to published guidelines and manufacturer’s recommendations.
• Reserve flashing, or immediate-use steam, for patient care items that will be used immediately in emergency situations when no other options are available.
• Limit traffic through the operating room, both the number of people and the number of door openings to only those that are essential.

Sterile and Surgical Technique

• Adhere to principles of sterile technique for all invasive surgical procedures.
• Protect primary incisions with a sterile dressing for 24-48 hours postoperatively.
• Perform intraoperative skin preparation with an alcohol-based antiseptic agent, unless contraindicated.
• Consider intraoperative irrigation of deep or subcutaneous tissues with aqueous iodophor solution. Intra-peritoneal lavage with aqueous iodophor solution in contaminated or dirty abdominal procedures is not necessary.
• The following strategies are not required to prevent SSIs:
  • Use of plastic adhesive drapes (with or without antimicrobial properties)
  • Application of a microbial sealant immediately following intraoperative skin preparation
• Research is inconclusive to support the following:
  • Soaking prosthetic devices in antisepsis solutions prior to implantation
  • Repeat application of antiseptic agents to the surgical site prior to closure