Surgical site infection prevention

What are surgical site infections & how to prevent them?

A surgical site infection (SSI) defined by the CDC is an infection that occurs after surgery in the part of the body where the surgery took place. They can sometimes be superficial infections involving the skin only.

Screening patients for existing infections before surgery

Research suggests the risk of surgical site infections increases up to nine times due to nasal colonization of staphylococcus aureus, presenting a big challenge in surgical settings. 30% of people are already nasally colonized with staphylococcus aureus when they reach the operating room.¹

Methicillin-resistant Staphylococcus aureus, also known as MRSA, is the leading cause of SSIs, and yet surgical settings don’t always include testing for it in their pre-operative care. Nasal swab tests allow you to detect and identify MRSA for better prevention and control. Screen patients for MRSA and decolonize carriers with an intranasal topical antimicrobial.

Monitoring & maintaining normal blood glucose before surgery

The CDC recommends screening preoperative blood sugar levels in patients undergoing select elective procedures such as arthroplasties and spinal fusions. Patients’ blood sugar level may rise due to the stress of the surgery, but high blood sugar delays wound healing and increases the chances for infection.²

It’s also important to maintain normal patient temperature. A lower-than-normal temperature during or after surgery can prevent oxygen from reaching the wound and makes it harder for the patient’s body to fight infection. Warming the room or bed can help.³

Both blood sugar levels and patient temperature need to be in the normal range to promote post-surgery healing.

Preparing patients’ skin before surgery

About 80% of skin flora occurs on the outside layers of the skin. In fact, one square centimeter of skin can host as many as 10 million aerobic bacteria, a leading cause of healthcare-acquired infections.⁴ 

Preparing patients’ skin for surgical procedures is a recommended practice in preventing surgical site infections. Patients should bathe or shower with CHG soap at least three days before surgery for best results, and a skin prep applicator should be used to help reduce skin flora and the risk of surgical site infections.

Prescribing antibiotics prior to surgery

Preoperative antibiotic prophylaxis is defined as administering antibiotics prior to performing surgery to help decrease the risk of postoperative infections. It is recommended that prophylactic antibiotics are administered at least 30 minutes, but no more than 60 minutes before the skin incision is made, and generally stopped within 24 hours after surgery.⁵

1: Price CS, Williams A, Philips G, Dayton M, Smith W, Morgan S.Staphylococcus aureus nasal colonization in preoperative orthopaedic outpatients. Clin Orthop Relat Res. 2008;466(11):2842-2847
2: Standardize Your Skin Prep Practices
3: https://www.aorn.org/outpatient-surgery/articles/special-editions/2018/may-infection-control/patient-warming-stops-ssis-cold
4: READMISSION RATES, CAUSES, AND COSTS FOLLOWING TOTAL JOINT ARTHROPLASTY IN US MEDICARE POPULATION W. Murphy, P.Lane, B. Lin, T. Cheng, D. Terry, S. Murphy; Bozic KJ, Kurtz SM, Lau E, et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res. 2010;468 (1):45-51)
5: https://www.aafp.org/afp/2011/0301/p585.html

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Be advised that information contained herein is intended to serve as a useful reference for informational purposes only and is not complete clinical information. This information is intended for use only by competent healthcare professionals exercising judgment in providing care. McKesson cannot be held responsible for the continued currency of or for any errors or omissions in the information.