GUIDELINES FOR THE PREVENTION OF SURGICAL SITE INFECTION

Preparation of the Patient

Level I:
• Identify and treat all infections remote to the surgical site before elective
operations. Postpone elective operations until the infection has resolved.
• Do not remove hair preoperatively unless hair at or near the incision site will
interfere with surgery. If hair is removed, it should be removed immediately beforehand,
preferably with electric clippers.

Level II:
• Control the blood glucose concentration in all diabetic patients.
• Encourage abstinence from tobacco for a minimum of 30 days before surgery.
• Indicated blood transfusions should not be withheld as a means to prevent
surgical site infection.
• Patients should shower or bathe with an antiseptic agent at least the night before
surgery.
• Wash and clean the incision site before antiseptic skin preparation.

Hand/Forearm Antisepsis

Level II:
• Keep nails short.
• Scrub the hands and forearms up to the elbows for at least 2–5 min with an
appropriate antiseptic.

Antimicrobial Prophylaxis

Level I:
• Administer antibiotic prophylaxis only when indicated.
• Administer the initial dose intravenously, timed such that a bactericidal
concentration of the drug is established in serum and tissues when the incision is made.
Maintain therapeutic levels of the agent in serum and tissues for the duration of the
operation. Levels should be maintained only until, at most, a few hours after the incision is
closed.
• Before elective colon operations, additionally prepare the colon mechanically
with enemas or cathartic agents. Administer nonabsorbable oral antimicrobial agents in
divided doses on the day before surgery.
• For high-risk cesarean section, administer the prophylactic antibiotic agent
immediately after the umbilical cord is clamped.

Level II:
• Do not use vancomycin routinely for surgical prophylaxis.
Surgical Attire and Drapes

Level II:
• A surgical mask should be worn to cover fully the mouth and nose for the
duration of the operation, or while sterile instruments are exposed.
• A cap or hood should be worn to cover fully hair on the head and face.
• Wear sterile gloves after donning a sterile gown.
• Do not wear shoe covers for the prevention of surgical site infection.
• Use surgical gowns and drapes that are effective barriers when wet.
• Change scrub suits that are visibly soiled or contaminated by blood or other
potentially infectious materials.

Asepsis and Surgical Technique

Level I:
• Adhere to principles of asepsis when placing intravascular devices or when
• dispensing or administering intravenous drugs.
• Level II: Handle tissue gently, maintain hemostasis, minimize devitalized or
charred tissue
• and foreign bodies, and eradicate dead space at the surgical site.
• Use delayed primary skin closure or allow incisions to heal by secondary
intention of the surgical site is contaminated or dirty.
• Use closed suction drains when drainage is necessary, placing the drain through
a separate incision distant from the operative incision. Remove drains as soon as possible.

Postoperative Incision Care

Level II:
• A sterile dressing should be kept for 24–48 h postoperatively on an incision
closed primarily. No recommendation is made regarding keeping a dressing on the wound
beyond 48h.
• Wash hands before and after dressing changes and any contact with the surgical
site.
• Use sterile technique to change dressings.
• Educate the patient about surgical site infections, relevant symptoms and signs,
and the need to report them if noted.
PATIENTS PRESENTS WITH COMPLAINT
EVALUATION AND MANAGEMENT OF CRITICALLY ILL PATIENT

ASSESSING NUTRIONAL STATUS

RISK FACTORS FOR DEVELEPING WOUND INFECTIONS
EMERGENCY MANAGEMENT OF BLEEDING