Practice Guidelines: Preventing Surgical Site Infections

Of the 30 to 41.5 million surgeries performed each year in the United States, surgical site infections affect an estimated 500,000 patients. These infections increase the length of patient stay from 3 to 10 days and increase the risk of death up to 11 times. In addition, surgical site infections increase the cost of care from $3,000 to $29,000 per incident, which translates to $10 billion annually.

By January 1, 2010, The Joint Commission expected accredited healthcare organizations to have fully implemented the National Patient Safety Goals’ requirements related to preventing healthcare-associated infections, including surgical site infections. To help your facility prevent these infections and reduce morbidity and mortality and their associated costs, these practice guidelines summarize recommended strategies related to modifiable intrinsic and extrinsic risk factors.

Strategies for Intrinsic, Patient-Related Risk Factors

  • For patients with diabetes mellitus, control the blood glucose level. Also, reduce the glycosylated hemoglobin A1c level to less than 7% before surgery, if possible.
  • For obese patients, increase the dosing of prophylactic antimicrobial drugs as appropriate. 
  • For smokers, encourage smoking cessation within 30 days before the procedure.
  • For patients on immunosuppressant therapy, recommend avoiding these drugs in the perioperative period, if possible.

Strategies for Extrinsic, Patient Preparation Risk Factors

  • Do not routinely shave or remove hair, unless it will interfere with surgery.
  • If hair removal is necessary, remove it by clipping or using depilatory cream. Do not use a razor.
  • Identify and treat infections remote to the surgical site, such as a urinary tract infection, before elective surgery.

Strategies for Extrinsic, Operative Risk Factors

  • For all surgical team members, use an antiseptic agent to perform a preoperative surgical scrub of the hands and forearms for 2 to 5 minutes.
  • Wash and clean around the incision site, using an appropriate antiseptic agent.
  • Administer antimicrobial prophylaxis, as prescribed.
    • Administer prophylaxis within 1 hour of incision (2 hours for vancomycin or fluoroquinolone).
    • Select an appropriate agent based on the surgical procedure and the most common pathogens, according to published recommendations.
    • Stop prophylaxis up to 24 hours after surgery for most procedures. For cardiac surgery, stop it within 48 hours.
  • Handle tissue carefully during surgery. 
  • Adhere to standard principles of operating room asepsis.
  • Minimize operative time as much as possible.

Strategies for Extrinsic, Operating Room Risk Factors

  • Follow the American Institute of Architects’ recommendations for ventilation. Verify with your Engineering Department that all of the recommendations are followed.
  • Minimize operating room traffic.
  • Clean surfaces and equipment with a hospital disinfectant approved by the U. S. Environmental Protection Agency.
  • Sterilize all surgical equipment according to published guidelines.
  • Minimize the use of flash sterilization.

For more details about preventing surgical site infections, see the lesson on this topic in The Joint Commission/OSHA Compliance course.

Infectious Diseases Society of America (IDSA). Anderson DJ, Kaye KS, Classen D, Arias KM, Podgorny K, Burstin H, et al. “Strategies to prevent surgical site infections in acute care hospitals.” Infection Control and Hospital Epidemiology. 2008; 29 Suppl. 1:S51-61.

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