Reducing Surgical Site Infections: Surgical Stewardship

By /

 

Surgical site infection (SSI) occurs in 2-5% of all surgeries which correlates to about 157,5000 SSIs in the U.S. on a yearly basis.1 Not only do SSIs impact patient outcomes and mortality rates, but also satisfaction scores and budgets of medical institutions.

In the webinar, Reducing Surgical Site Infections: Surgical Stewardship, Maureen P. Spencer discusses key infection control initiatives within the perioperative service line that should be used with a bundled approach.2

Surgical stewardship is focused on optimizing patient outcomes.

When combined with an approach such as the 7 S Bundle, a perioperative nurse can control SSI risk before, during, and after a surgical procedure2:

 

  1. Safety – A safe operating room (OR) is crucial for preventing SSI. Surface sterilization procedures should be performed in advance including all equipment, lights, and the operating bed. Airborne sterilization should be kept intact through traffic control and air ventilation monitoring along with keeping door openings to a minimum for reduced SSI risk
  2. Screen – By analyzing a patient’s pre-op condition, a nurse can determine any risk factors and the presence of methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-resistant Staphylococcus aureus (MSSA) prior to surgery. Nasal decolonization is becoming an important step for screening in response to COVID-19 and nasal carriage of S.aureus.
  3. Showers – Patients should arrive to their surgical appointment with physically clean skin. Patient should be instructed to shower with soap or chlorhexidine gluconate (CHG) the night before and morning of their surgery.
  4. Skin Prep – Skin preparation with alcohol-based antiseptics, such as CHG/alcohol or iodophor/alcohol provide rapid protection of the surgical site surface before and after the procedure for controlled SSI prevention.
  5. Solution – Surgical irrigation to remove exogeneous contaminants prior to wound closure should be a common practice in every OR, but there is a lack of process standardization. Processes are moving away from using antibiotic irrigations and more towards the use of antiseptic irrigations such as chlorhexidine.
  6. Sutures – Sutures can be colonized by bacteria like other foreign bodies; therefore, an antimicrobial suture provides needed protection in comparison to a traditional suture. Closing sutures with Triclosan coated antimicrobial sutures is a simple control measure to prevent SSI.
  7. Skin Closure- Topical skin adhesives can be the best approach to preventing exogeneous contamination in a postoperative setting in addition to transparent antimicrobial dressings.

To strengthen SSI prevention, Spencer notes that medical institutions have to adopt and utilize optimal perioperative care and evidence-based practices, such as the 7 S Bundle, within their own medical culture including the perioperative nurse, the entire OR and beyond.

To learn more, view the full webinar here.