Emory University Hospital

Atlanta, GA

Citation

Sullivan P, Castleberry C, Tripathi S. SSI prevention checklist – Colorectal protocol. Emory Healthcare. http://www.med.emory.edu/education/vme/SSIPrevention/Colorectal/index.html. Accessed October 5, 2015.

Sharma J. Implementation of a NSQIP based wound infection prevention process (WIPP) reduces surgical site infections. Talk presented at: Reducing SSI: A roadmap to successful implementation; June 28, 2015; Nashville, TN.

Results

Pre-Bundle Post-Bundle
SSI Rate: 18.79% SSI Rate: 8.17%

SSI Prevention Bundle for Colorectal Surgery

Preoperative
Set OR Temperature

Set operating room temperature to between 72° and 75° F.

Pre-Incision
Administer Antibiotic

Typical dose is Ancef (2g) and Flagyl (500mg).

Administer within one hour of incision.

If PCN allergy, give clindamycin (900mg) and aztreonam (2g).

Prep Skin

Use Chloraprep® (Betadine® for perineum).

Allow for 3 minute drying time.

Perform Universal Prep

Use sterile draping techniques and Ioban occlusive to decrease risk of openings for contamination.

Towel Surgical Site. Use sterile towels to frame surgical site.

Apply Drape. Drape surgical site. Either universal or laparotomy with pockets (surgeon’s preference).

Use Ioban. Place Ioban covering over surgical site.

Double Glove

All surgical team double-gloves.

Initiate Intraoperative Warming

Initiate intra-operative warming of patient.

Prepare Closing Pan

Items to include on small Mayo: closing sutures, sterile towels, fresh gloves, closing pan instruments, Bovie, and suction. Cover pan with sterile protection until needed.

Intraoperative
Use Alexis Wound Protector

Use Alexis wound protector to prevent contamination and trauma to abdominal wall.

Perform Irrigation

Perform abdominal wound irrigation with antibiotic solution.

Appropriate dose is: 500ml warm NaCl, Gentamycin (240mg) and Clindamycin (600mg).

Closing
Remove Instruments

Remove hardware and instruments from field; keep drapes. Remove wound protector.

Retrieve Closing Pan

Bring prepared closing table close to patient.

Re-Glove

All surgical team re-gloves.

Remove outer gloves and replace.

Gowns are done if preferred by surgeon.

Re-Towel Surgical Wound

Re-towel the surgical wound with the towels from prepared closing pan.

Pass Off New Suction and Bovie

Pass off new Bovie and suction from prepared closing pan.

Close Fascia

Close fascia with new instruments from closing pan.

Do not reuse instruments.

Close Skin

Close skin - staples or suture - surgeon preference.

Skin should be left open for Class III and IV wounds.

Apply Sterile Dressing

Apply sterile dressing prior to taking off sterile drapes.

Peel back Ioban without going outside sterile field.

Primapore or sterile 4x4 with tegaderm (surgeon preference).