Perioperative Strategies for Surgical Site Infection Prevention

Posted by Lauren Burke on

Creating Strategies to Prevent SSIs

The primary goal of perioperative procedures is to provide better care before, during and after the surgery to reduce the risks of infection. Hand hygiene is paramount during this time because it is easy for personnel to transfer a pathogen such as Staphylococcus or Escherichia coli from something they touch to the patient’s skin.

Before and after surgery perioperative nurses manage many tasks along with patient care. They enter notes and monitor orders, for example, using a computer keyboard that will have bacteria on the surface. Along with good hand hygiene, a focus on antimicrobial irrigation is crucial.

The Importance of Antimicrobial Irrigation

Studies indicate that a surgical site infection typically develops in the time from incision to closure. Antimicrobial irrigation during the procedure has multiple benefits such as:

  • Removes contamination that can lead to infection and interfere with healing. When the physician makes the initial incision, bacteria and debris from the skin will move into the wound. Irrigating that open area with fluid will wash the tissue and decrease the risk of microbial contamination.
  • Improves visualization for the surgeon - Better visualization allows the surgeon to tie off small bleeders.
  • Hydrates tissue for better healing.
  • Irrigation Solutions

Ultimately, it is up to the presiding surgeon to determine what solution to use for irrigation. Some physicians might order a basic saline solution, or saline with an antimicrobial added such as chlorhexidine gluconate. In some cases, antibiotics such as bacitracin, cefazolin and gentamicin are used in irrigation solutions.

A 2013 survey by the Association of Perioperative Registered Nurses (AORN) found:

  • Fifty-one percent of irrigation strategies utilized normal saline
  • Thirty-five percent used saline with an antibiotic usually Bacitracin
  • Twenty-six percent relied on povidone iodine

In a 2012 annual meeting of the American College of Surgeons and the Association for Professionals in Infection Control and Epidemiology referred to the use of a 0.05 percent chlorhexidine gluconate solution for antimicrobial irrigation.

Taking a Bundled Approach to Infection Prevention

The Institute for Healthcare Improvement recommends perioperative strategies include two or more ways to minimize the risk of SSI development such as:

  • Decolonizing skin before admission
  • Surgical skin preparation
  • Antimicrobial irrigation

Surgical site infections impact both the patient and the medical facility. Proven control methods like antimicrobial irrigation and hand hygiene can greatly reduce their risk.

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