Prevention Strategies

Prevention Strategies - Setting the Stage

• Patient Optimization:
  • Nutrition, smoking cessation.
  • Glycemic control: Target <180-200 mg/dL.
  • MRSA decolonization if indicated.
• Antibiotic Prophylaxis: 📌 "TIME": Timing, Indication, Medication, End.
  • Timing: Within 60 min before incision.
  • Selection: Procedure-specific (based on common pathogens).
  • Re-dosing: Long procedures (e.g., >2 half-lives, >4h), major blood loss (>1.5L).
  • Discontinuation: Within 24h post-op.

  ⭐ Vancomycin infusion should start within 120 minutes before surgical incision due to longer infusion time.

• Skin & Hair:
  • Skin Prep: Chlorhexidine-alcohol (CHG-Alc) preferred; apply from center to periphery.
  • Hair Removal: Clip (not shave) immediately before surgery if hair interferes with surgery.

Prevention Strategies - Sterile Fortress

• OR Environment:
  • Positive pressure ventilation (>15 ACH), HEPA filters for air purity.
  • Limited OR traffic; strict surface cleaning & disinfection protocols.
• Surgical Team:
  • Strict hand hygiene (surgical scrub). 📌 Mnemonic: "Clean Hands Save Lives."
  • Sterile attire: gowns, double gloves (recommended), masks, caps/hoods.
• Surgical Technique (Aseptic & Atraumatic):
  • Gentle tissue handling; minimize devitalized tissue, hematoma, and dead space.
  • Judicious electrocautery use; select appropriate suture materials.
  • Wound irrigation (e.g., normal saline); consider impervious wound protectors.
• Instrument Sterilization:
  • Autoclaving: steam at 121°C (250°F) for 15-20 min at 15 psi. Verify with indicators.
• Sterile Field Maintenance:
  • Unyielding maintenance of sterile drapes and instrument field integrity.

⭐ Maintaining intraoperative normothermia (core temperature >36°C) is crucial; hypothermia significantly ↑ SSI risk.

Prevention Strategies - Healing Shield

• Wound Management:
  • Maintain sterile dressing for 24-48h post-op.
  • Strict hand hygiene before & after dressing changes.
  • Choose dressing type based on wound characteristics (e.g., absorbent for exudative wounds).
• SSI Surveillance:
  • Monitor for Surgical Site Infection (SSI) using CDC criteria: superficial, deep, organ/space.
  • Signs: 📌 REEDA (Redness, Edema, Ecchymosis, Discharge, Approximation); also look for increasing pain, swelling, purulent discharge, or fever.
  • Timing: Usually manifests within 30 days post-op, or within 1 year if an implant is present.
• Key Systemic Measures:
  • Optimize glycemic control.
  • Appropriate post-op antibiotic use: Discontinue prophylactic antibiotics within 24h for most surgeries.

⭐ Most SSIs manifest between the 5th and 10th post-operative day.

Prevention Strategies - Checklist Champions

• Care Bundles: Grouped evidence-based practices performed collectively to improve outcomes (e.g., SCIP measures).
• WHO Surgical Safety Checklist: Crucial for enhancing teamwork and communication.
  • Sign In: Before anaesthesia induction (patient ID, site, consent).
  • Time Out: Before skin incision (critical steps, antibiotics).
  • Sign Out: Before patient leaves OR (specimens, equipment).

  ⭐ The WHO Surgical Safety Checklist has been shown to significantly reduce both morbidity and mortality.

• SSI Prevention Bundles: Specific sets of interventions for high-risk surgeries.
  • Example: Colorectal Surgery Bundle
    • Pre-op: Oral antibiotics + mechanical bowel prep.
    • Intra-op: Appropriate antibiotic prophylaxis, maintain normothermia, strict glucose control (target < 200 mg/dL).

High‑Yield Points - ⚡ Biggest Takeaways

• Hand hygiene is the cornerstone of SSI prevention.
• Administer prophylactic antibiotics (e.g., Cefazolin) within 1 hour before surgical incision.
• Use chlorhexidine-alcohol for skin antisepsis; superior to povidone-iodine.
• Maintain intraoperative normothermia (core temp >36°C) to reduce SSI risk.
• Optimize perioperative glycemic control (target blood glucose <180-200 mg/dL).
• If hair removal is needed, use clippers immediately pre-surgery; avoid razors.
• Strict aseptic techniques and minimal OR traffic are vital to prevent SSIs.