Table 1 ACS-NSQIP Best Practice SSI Prevention Bundle
Preoperative | Intraoperative | Postoperative |
|---|---|---|
Patient-Related | Patient-Related | Patient-Related |
Encourage patient to discontinue tobacco use for at least 30 days prior to operation | Monitor and maintain glucose levels (< 200 mg/dl) in cardiothoracic surgery patients, including non-diabetic patients | Monitor and maintain glucose levels (< 200 mg/dl) in cardiothoracic surgery patients, including non-diabetic patients |
Identify and treat all non-surgical site infections prior to surgery. Postpone elective operations if necessary | Discontinue prophylactic antibiotics within 24 h after noncardiac surgery and 48 h after cardiac surgery | Discontinue prophylactic antibiotics within 24 h after noncardiac surgery and 48 h after cardiac surgery |
Administer prophylactic antibiotics within one hour prior to surgery (vancomycin and fluoroquinolones should be administered two hours prior to surgery). Select the appropriate antimicrobial prophylaxis based on evidence-based guidelines | Cover primarily closed incisions with a sterile dressing for 24 to 48 h postoperatively. Wash hands before and after any contact with surgical site. | Cover primarily closed incisions with a sterile dressing for 24 to 48 h |
Adjust the dose of the prophylactic antibiotics for morbid obesity | ||
Provider-Related | Provider-Related | |
Keep nails short. Do not wear artificial nails or hand or arm jewelry | Wear a cap or hood to fully cover head/facial hair and a surgical mask to cover nose/mouth when entering the operating room (if operation is about to begin, is underway, or surgical instruments are exposed) and until the conclusion of the operation. | |
Clean underneath fingernails prior to first daily surgical scrub. Complete a two to five minute preoperative scrub using appropriate antiseptic or use alcohol-based surgical antiseptic | Use surgical gown and drapes that are liquid resistant | |
Wear sterile gloves if a scrubbed surgical team member | ||
Change surgical scrubs if grossly soiled or contaminate | ||
System-Related | ||
Comply with standards regarding operating room asepsis | ||
When visible contamination of surfaces/equipment with body fluids occurs, use an Environmental Protection Agency-approved cleaning solution to clean affected area before next operation |