Surgical site infections are the most common and costliest healthcare-associated infection, but 60 percent of SSIs have been estimated to be preventable through the use of evidence-based guidelines, according to a recent article in Infection Control and Hospital Epidemiology.
The expert guidance document, "Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update," was a collaborative effort led by the Society for Healthcare Epidemiology, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology and The Joint Commission.
The document lays out 15 best practices to prevent SSIs that the authors say should be adopted by all acute-care hospitals.
1. Administer antimicrobial prophylaxis according to evidence-based standards. This should be administered within one hour before incision.
2. Don't remove hair at the operating site unless the hair will interfere. And if hair removal is necessary, it should be done outside of the operating room using clippers or a depilatory agent, not razors.
3. Control glucose during postoperative period for both cardiac and noncardiac surgery patients. The goal should be to maintain a blood glucose level of 180 mg/dL or lower.
4. Maintain a temperature of 35.5 degrees Celsius in perioperative period. Hypothermia, even mild degrees of it, can increase SSI rates.
5. Administer supplemental oxygen during and following surgical procedures that involve mechanical ventilation. This optimizes tissue oxygenation.
6. Use preoperative skin prep agents that contain alcohol if no contraindication exists.
7. Use impervious plastic wound protectors for GI and biliary tract surgery. A meta-analysis of clinical trials found using these protectors was associated with a 45 percent decrease in SSIs.
8. Use a checklist to ensure compliance with best practices. The authors recommended using a checklist based on the 19-item surgical safety World Health Organization checklist.
9. Perform surveillance for SSIs. Not only should hospitals choose targeted procedures for indirect surveillance, but postoperative surveillance should also be performed. Surveillance should also be performed on patients who are readmitted to the hospital.
10. Use automated data to increase surveillance efficiency.
11. Provide ongoing feedback of SSI rates. Feedback should be given to surgical and perioperative personnel and hospital leaders. The authors recommend anonymously benchmarking procedure-specific, risk-adjusted rates of SSIs among surgeons.
12. Give feedback to providers on rates of compliance with process measures. This feedback should be given to surgical staff, perioperative personnel and leadership.
13. Educate surgical staff about SSI prevention.
14. Educate patients and families about SSI prevention. Giving preprinted materials to patients is especially effective. Information should include instructions and strategies for reducing SSI risk.
15. Implement policies aimed at reducing the risk of SSIs that align with evidence-based standards.
More Articles on Surgical Site Infections:
Most Common Healthcare-Associated Infections: 25 Bacteria, Viruses Causing HAIs
11 Tips for Reducing SSIs
3 Tips to Prevent Cardiac SSIs From Cleveland Clinic