Prevention of Surgical Site Infection

- Introduction

The aim of these guidelines is to provide a comprehensive range of evidence-based recommendations for interventions to be applied during the pre-, intra- and postoperative periods for the prevention of SSI, while also considering aspects related to resource availability and values and preferences.

Surgical site infections (SSIs) are potential complications associated with any type of surgical procedure. Although SSIs are among the most preventable HAIs. they still represent a significant burden in terms of patient morbidity and mortality and additional costs to health systems and service payers worldwide. Up to 60% of SSIs are preventable using evidence-based guidelines. When not prevented, SSIs can result in a significant increase in postoperative hospital days and many also require reoperation, both during the initial surgical admission and during hospital readmission. For these reasons, the prevention of SSI has received considerable attention from surgeons, infection control professionals and health care authorities.

A Surgical Site Infection prevention bundle is a structured approach that combines several evidence-based practices to reduce the risk of infections occurring at or near the surgical incision. SSIs are a significant complication of surgery, leading to increased patient suffering, prolonged hospital stays, higher healthcare costs, and even mortality.

The introduction of an SSI prevention bundle guideline aims to:

●  Reduce the incidence of SSIs: By implementing a set of proven strategies, the bundle minimizes the chances of bacteria or other microorganisms contaminating the surgical site during, before, or after an operation.

●  Standardize care: The guideline provides a consistent and evidence-based framework for all healthcare professionals involved in surgical procedures. This ensures that all patients receive the same high level of preventative care.

●  Improve patient outcomes: Lowering the rate of SSIs leads to fewer complications, faster recovery times, and a decreased risk of readmission for patients undergoing surgery.

●  Promote a multidisciplinary approach: Successful implementation of an SSI bundle requires collaboration and adherence from surgeons, nurses, anesthesiologists, and other members of the surgical team.

●  Provide a basis for quality improvement: The bundle's components can be monitored and audited to assess compliance and identify areas for improvement in surgical practices.

●  Educate healthcare professionals: The guideline highlights key preventative measures, reinforcing their importance and ensuring that staff are knowledgeable about best practices.

A typical SSI prevention bundle often includes interventions across the perioperative period (before, during, and after surgery). While the specific components can vary depending on the type of surgery and the healthcare setting, common elements often include:

➡️Preoperative Phase:

●  Patient education: Informing patients about the importance of hygiene and what to expect before and after surgery.

●  Preoperative showering or bathing with antiseptic soap (e.g., chlorhexidine): Reducing the bacterial load on the patient's skin.

●  Proper hair removal (if necessary) using  medical clippers: Avoiding razors, which can cause skin micro-abrasions. Use hair removal cream after doing sensitivity test for the patient if medical clipper is not available.

●  Appropriate and timely administration of prophylactic antibiotics: Giving antibiotics within a specific timeframe before the incision to prevent bacterial growth during the procedure.

●  Glycemic control: Managing blood sugar levels, especially in diabetic patients, as hyperglycemia can increase infection risk.

●  Smoking cessation counseling: Encouraging patients to stop smoking before surgery, as smoking impairs wound healing and increases infection risk.

●  Nutritional optimization: Ensuring patients are adequately nourished to support their immune system and wound healing.

➡️Intraoperative Phase:

● Surgical hand antisepsis: Surgeons and surgical staff performing thorough hand hygiene.

●   Skin preparation with an antiseptic solution (e.g., chlorhexidine with alcohol): Cleaning the surgical site immediately before the incision.

●   Maintaining normothermia: Keeping the patient warm during surgery, as hypothermia can impair immune function.

●  Appropriate surgical attire and draping: Using sterile gowns, gloves, and drapes to maintain a sterile field.

●  Minimizing traffic in the operating room: Reducing the number of people entering and exiting the surgical area.

● Using sterile instruments and supplies: Ensuring all equipment used during the surgery is properly sterilized.

●  Gentle tissue handling: Minimizing tissue trauma during the procedure to promote healing.

●  Appropriate wound irrigation: Washing the surgical site with sterile solution.

●   Considering the use of wound protectors: Devices that can help prevent contamination of the wound edges.

●  Glove and instrument changes: Changing gloves and instruments at specific points during the procedure, especially after handling contaminated areas.

Postoperative Phase:

●   Proper wound care: Following established protocols for dressing changes and wound assessment.

●  Early mobilization: Encouraging patients to move as soon as safely possible to improve circulation and healing.

●  Pain management: Adequate pain control can contribute to better overall recovery.

●   Continued glycemic control: Maintaining stable blood sugar levels postoperatively.

●  Judicious use of postoperative antibiotics: Avoiding routine use of antibiotics after surgery unless there is a clear indication of infection.

●   Surveillance for infection: Monitoring the surgical site for signs and symptoms of infection.

●  Patient education on wound care and signs of infection: Empowering patients to recognize and report potential problems after discharge.