Surgical Site Infection

Prevention

Pre-Operative

  • Optimise patient’s medical co-morbidities
    • Tight diabetic control
    • Nutritional status
  • Smoking cessation
  • Screen for MRSA

Peri-Operative

Patient Preparation

  • Shave hair with clippers at the time of surgery
  • Perform a pre-wash for non-elective trauma cases
  • Skin Preparation
    • Alcoholic 2% chlorhexidine or alcoholic povidone-iodine

Antibiotic Prophylaxis

  • For contaminated cases and clean cases with prosthesis insertion
  • Administer within 1 hour of incision & prior to tourniquet use (local policy)
  • Repeat antibiotic dosage if surgery is prolonged
  • Avoid unnecessary use to prevent resistance

Theatre Issues

  • Use laminar flow
  • Minimise theatre traffic

Hands

  • Good hand washing technique
    • Use 2% chlorhexidine or povidone-iodine
    • Remove all jewellery

Drapes & Clothing

  • Use disposable drapes
  • Wear disposable gowns
  • Change clothing on leaving the theatre suite
  • Use different shoes for inside and outside the theatre

Surgical Technique and Wound Management

  • Perform efficient surgery:
    • Minimal soft tissue damage and skin handling
    • Avoid long tourniquet times
    • Ensure haemostasis to prevent blood loss
    • Use sound wound closure techniques
    • Apply see-through interactive dressings

Anaesthesia

  • Maintain steady body temperature to avoid hyperthermia or hypothermia

Post-Operative

  • Use ring-fenced beds for elective cases
  • Allocate side rooms for infectious patients
  • Breed a good ward culture for infection control
  • Minimise dressing changes
  • Use aseptic technique if dressing changes are necessary
  • Apply see-through interactive dressings
  • Wash hands between each patient contact
  • Treat oozing wounds aggressively
  • Avoid unnecessary use of antibiotics
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