Policy Name:
Surgical Site Infection Prevention
Approved Date:
Section:
Infection Control
Review Date:
Policy #:
Revised Date:
Purpose:
To establish protocol for waived testing
PURPOSE
To promote best practices for Surgical Site Infection (SSI) prevention.
POLICY
I.
II.
The ambulatory surgery center will work toward preventing SSIs by implementing the
following components of care:
A.
Appropriate use of prophylactic antibiotics;
B.
Appropriate hair removal;
C.
Normothermia
Appropriate Use of Prophylactic Antibiotics
A.
The antibiotic process measures for prevention of SSIs are these:
1.
Prophylactic antibiotic received within 1 hour prior to surgical incision*
2.
Prophylactic antibiotic selection for surgical patients consistent with national
guidelines (as defined in TJC/CMS Specification Manual and SCIP for Measure
SCIP-Inf-2, Medical Letter)
3.
Prophylactic antibiotics discontinued within 24 hours after surgery end time.
4.
It is worth noting that these measures apply to antibiotics administered for SSI
prophylaxis only. The definition of the measures in SCIP excludes patients who are
already receiving antibiotics for other reasons. It often is not necessary to administer
an additional antibiotic or dose in such cases, as this only leads to unnecessary
administrations which should be avoided.
5.
Due to the longer infusion time required for vancomycin, it is acceptable to start this
antibiotic (e.g., when indicated because of beta-lactam allergy or high prevalence of
MRSA) within 2 hours prior to incision.
6.
Process and systems changes that have led to improved performance on the
antibiotic use measures include:
a.
Use preprinted or computerized standing orders specifying antibiotic,
timing, dose, and discontinuation.
b.
Change operating room drug stocks to include only standard doses and
standard drugs, reflecting national guidelines.
c.
Assign dosing responsibilities to anesthesia or designated nurse (e.g., pre-op
holding or circulator) to improve timeliness.
Involve pharmacy, infection control, and infectious disease staff to ensure
appropriate timing, selection, and duration.
Verify administration time during “time-out” or pre-procedural briefing so
action can be taken if not administered.
d.
e.
III.
Appropriate Hair Removal
A.
The use of razors prior to surgery increases the incidence of wound infection when
compared to clipping, depilatory use, or no hair removal at all. When hair must be removed
to safely perform the procedure, it should never occur with a razor. The use of clippers has
been found to be the best method in many facilities, as depilatory creams can cause skin
reactions.
1.
2.
3.
4.
5.
IV.
Ensure adequate supply of clippers and train staff in proper use.
Use reminders (signs, posters).
Educate patients not to self-shave preoperatively.
Remove all razors from the center.
Work with the purchasing department so that razors are no longer purchased.
Normothermia
A.
Maintaining the patient's internal temperature has been found to help reduce the risk of postoperative infection.
B.
Use a warming device.
References:
5 Million Lives Campaign. Getting Started Kit: Prevent Surgical Site Infections How-to
Guide. Cambridge, MA: Institute for Healthcare Improvement; 2008.
http://www.ihi.org/IHI/Topics/PatientSafety/SurgicalSiteInfections/
Yokoe DS, Mermel LA, Classen, D, et al. A compendium of strategies to prevent
healthcare-associated infections in acute care hospitals. Infect Control Hosp Epidemiol.
2008; 29:S12-S21.
http://www.shea-online.org/about/compendium.cfm