Prevention of Surgical Site Infection

Recommendations

Preoperative and Intraoperative Measures

Preoperative bathing

Ensure that the patient has showered (or bathed/washed if unable to shower) using either a plain or antimicrobial soap on day of or day before surgery (Conditional Recommendation)

Screening and decolonization of MRSA

patients undergoing cardiothoracic or orthopaedic surgery with known nasal carriage of MRSA should receive perioperative intranasal applications of mupirocin 2% ointment with or without a combination of CHG body wash (Strong Recommendation)

treat also patients with known nasal carriage of MRSA undergoing other types of surgery with perioperative intranasal applications of mupirocin 2% ointment with or without a combination of CHG body wash (Conditional Recommendation)

Optimal timing for preoperative surgical antibiotic prophylaxis

We recommend administration of SAP prior to the surgical incision when indicated (depending on the type of operation) (Strong Recommendation)

We recommend administration of SAP within 120 minutes before incision, while considering the half-life of the antibiotic (Strong Recommendation)

Mechanical bowel preparation and the use of oral antibiotics

Consider the use of oral antimicrobial prophylaxis prior to elective colorectal surgery to reduce the risk of SSI  (Conditional Recommendation)

Consider the use of mechanical bowel preparation (MBP) should be used to reduce the risk of SSI in adult patients undergoing elective colorectal surgery (Conditional Recommendation)

Orthopedic and cardiothoracic procedures

Decolonize surgical patients with an anti-staphylococcal agent in the preoperative setting for orthopedic and cardiothoracic procedures (Strong Recommendation)

Hair removal

In patients undergoing any surgical procedure, hair should either not be removed or, if absolutely necessary, it should be removed only with a clipper. Shaving is strongly discouraged at all times, whether preoperatively or in the operating room (OR) (Strong Recommendation)

Surgical site preparation

We recommend using alcohol-based antiseptic solutions based on CHG for surgical site skin preparation in patients undergoing surgical procedures (Strong Recommendation)

Surgical hand preparation

Surgical hand preparation should be performed either by scrubbing with a suitable antimicrobial soap and water or using a suitable ABHR before donning sterile gloves (Strong Recommendation)

Maintaining normal body temperature (normothermia)

Use of warming devices in the operating room and during the surgical procedure for patient body warming with the purpose of reducing SSI (Conditional Recommendation)

For procedures not requiring hypothermia, maintain normothermia (temperature > 35.5°C) during the perioperative period (Strong Recommendation)

Postoperative Measures

Surgical antibiotic prophylaxis prolongation

Control blood-glucose level during the immediate postoperative period for all patients (Strong Recommendation)

It’s recommended against the prolongation of SAP administration after completion of the operation for the purpose of preventing SSI (Strong Recommendation)

Use a checklist and/or bundle to ensure compliance with best practices to improve surgical patient safety. (Strong Recommendation)

Perform surveillance for SSI. (Strong Recommendation)

Provide ongoing SSI rate feedback to surgical and perioperative personnel and leadership (Strong Recommendation)

Observe and review practices in the preoperative clinic, postanesthesia care unit, surgical intensive care unit and surgical ward (Moderate Recommendation)