Golisano Children’s Hospital at University of Rochester Medical Center

Rochester, Minnesota

Citation

Schriefer J, Sanders J, Michels J, Wolcott K, Ruddy C, Hanson J. Implementation of an Orthopaedic Bundle to Reduce Surgical Site Infections. Orthopaedic Nursing. 2017;36(1):49–59.

Results

Pre-Bundle Post-Bundle
Total SSI rate: 4% Total SSI rate: 0%

SSI Prevention Bundle for Pediatric Orthopaedic Surgery (Low Risk Patients)

Preoperative
Antibiotic Prophylaxis

Weight-based prophylactic antibiotic

Nutrition Evaluation

No nutritional labs drawn if BMI is normal

Antiseptic Skin Cleansing

2% CHG wipes day of surgery

Staphylococcus aureus Screening and/or Decolonization

Preoperative providone-iodine nasal antiseptic swabs postinduction by anesthesiologist

Warming

Pre-warm using blankets and thermal wear

Normothermia

Pre-warm operating room to 75°F

Intraoperative
Antibiotic Prophylactic

Cefazolin (1 hr before incision) and Vancomycin (2 hr before incision) if MRSA suspected

Discontinue Foley

Discontinue within 24-48 hrs postoperative

Wound Dressing

Standardized intraoperative dressing application

Normothermia

Patient Temperature above 36°C

SSI Prevention Bundle for Pediatric Orthopaedic Surgery (High Risk Patients)

Preoperative
Antibiotic Prophylaxis

Weight-based prophylactic antibiotics

Nutrition Evaluation

Pre-albumin and Vitamin D screening

Antiseptic Skin Cleansing

2% CHG wipes the night before surgery and day of surgery

Staphylococcus aureus Screening and/or Decolonization

Preoperative povidone-iodine nasal antiseptic swabs postinduction by anesthesiologist

Warming

Pre-warm using blankets and thermal wear; spine cases pre-warm with Bair hugger

Intraoperative
Antibiotic Prophylactic

Cefazolin (1 hr before incision) and Vancomycin (2 hr before incision) if MRSA suspected; bone graft antibiotics for spine surgery

Discontinue Foley

Discontinue within 24-48 hrs postoperative

Wound Dressing

Standardized intraoperative dressing application

Normothermia

Patient temperature above 36°C