Stony Brook University Hospital

Stony Brook, New York

Citation

Connolly TM, Foppa C, Kazi E, Denoya PI, Bergamaschi R. Impact of surgical site infection reduction strategy after colorectal resection. Colorectal Dis. In press.

Results

Pre-Bundle Post-Bundle
Total SSI rate: 32.2% Total SSI rate: 19%

SSI Prevention Bundle for Colorectal Surgery

Pre-Hospital
Bowel preparation Over the counter enema 2 hours prior to leaving home for hospital Neck down shower with chlorhexidine at completion of prep and after clear BM
Chlorhexidine antimicrobial scrub of abdomen morning of surgery
Preoperative
Improved LIP questions to determine patient readiness for OR

-% bowel prep consumed
-Color of last stool
-Over the counter enema 2 hours prior to leaving home for hospital
-Neck down shower with chlorhexidine at completion of prep and after clear BM
-Chlorhexidine neck down shower with additional antimicrobial scrub of abdomen morning of surgery

Blood glucose – PSA Check (goal <200) in PSA

-Consider delay of case ≥200 – 349
Consider cancelation of case if ≥350

Hair removal complete in PSA before going to OR

Intraoperative
Staff will insist and ensure surgical masks are worn at all times in the OR Staff will minimize traffic and the OR door “left open” time Staff will minimize traffic and the OR door “left open” time Use of chlorhexidine skin prep unless contraindicated (Stoma/Allergy)

-Substitute Betadine when contraindicated: Allow to air dry

Skin prep area extended from nipple line to knees: side to side

-Area inclusive of posterior axillary line

Attending will be present in OR during skin prep to observe staff performing skin prep as per established guidelines

-Staff will be reeducated at point of care by attending if prep does not meet standard expected

OR team operating within the sterile field will prepare for the case utilizing chlorhexidine scrub brush for more than 2 minutes (this includes the scrub nurse)

-Chlorhexidine/alcohol-based preoperative hand antiseptics will not be considered an acceptable substitute for traditional brush hand scrubbing

Clean scrubs must be worn at the start of every colorectal case (staff within the sterile field) Scrubs worn during a case will not be worn outside of the OR (Surgeon)

-Surgeons will change into clean scrubs prior to entering OR or leaving OR

Prophylactic antibiotic will be administered within 60 minutes of incision time for optimal results
Place iodine-impregnated incision drape over abdomen Put Alexis wound retractor in place Prior to closing the abdominal wall the OR team operating within the sterile field will:
  1. Re-glove
  2. Re-prep
  3. Re-towel incision area
  4. Utilize reserved unused clean instrument tray for closing
Wound closure guidelines to be followed Normothermia (SCIP ≥36.0°C)

-Discuss/address patient temperature at debriefing prior to surgeon leaving OR

Sticker with dressing change instructions placed on dressed wound
Postoperative
Do not leave OR in scrubs except when directly walking to and from office to change to street clothes Discontinuation of antibiotic within 24 hours (SCIP) Foley catheter removal by POD #2 (SCIP)
Glucose control (SCIP cardiac surgery measure) Appropriate hand hygiene/gloves on floor Dressing changes using sterile technique
Prior to patient DC; attending review of wound