Preventing Surgical Site Infections (SSI)

The number of surgical procedures performed in the industrialised nations of Europe is steadily increasing. The prevention of surgical site infections (SSI, postoperative wound infection) is therefore becoming an increasingly important issue. SSI is currently the second most common cause of hospital acquired infections (HAIs) in Europe. The Robert Koch Institute (KRINKO) provides detailed recommendations for avoiding SSI in all three phases of an operation. Preventive measures can help to avoid most infections that occur during surgery.

Phase 1 preoperative
Phase 2 intraoperative
Phase 3 postoperative
Phase 1 preoperative

Further information

Preparing the patient

  • Recommendation: perform a full body wash on the evening before or on the day of surgery.1
  • If it is necessary to remove hair use a clipper rather than a razor.1
  • Depending on the indication, perform S. aureus screening and where applicable decolonisation (mupirocin, nasal).1

Bathing before surgery No shaving but clipping Decolonisation of S. aureus (intranasal mupirocin)

Further information

Disinfection

  • Follow the hygiene regulations applicable in your department for

    o surface disinfection
    o hand disinfection
    o hand washing

Hand disinfection Hand wash

Further information

OR clothing & gloves

  • Medical single-use gloves are primarily designed to interrupt infection chains.3
  • Don scrub suits, hair cover and OR shoes before entering the surgery department, also don mouth/nose cover before entering the OR.1
  • Change the mouth/nose cover before every procedure and when there is visible contamination.1

Wear examination gloves where recommended. Change OR area clothing, surgical shoes, surgical cap, surgical mask, mouth and nose protection (MNS) before each operation & in case of visible soiling

Further information

Antibiotic prophylaxis (PAP)

  • Use antibiotics only when recommended.2

Use of antibiotics only when recommended

Phase 2 intraoperative

Further information

Surgical hand disinfection

  • Is performed by all those in the OR to eliminate transient skin flora and to reduce resident flora as much as possible.1

Surface disinfection

Further information

OR clothing

  • Don sterile OR gowns.1
  • Recommendation: wear goggles/face protection when there is risk of spurting body fluids or irrigation fluids.1

Sterile gowns (standard and high performance), protective shield in the OR where aerosol or secretions are present

Further information

Normothermia

  • Maintain normal body temperature in the patient, using active warming if necessary, unless hypothermia is clinically required.1,2

Devices for patient body warming

Further information

Wear two pairs of gloves (double gloving)

  • Recommendation: wear two pairs of gloves in operations in which there is an increased risk of glove damage.1

Double gloving in the OR (sterile gloves)

Further information

Skin disinfection of the patient

  • Perform thorough antisepsis of the skin of the operating area with an alcohol-based skin antiseptic.1

Patient’s skin disinfection

Further information

Environment

  • Ensure use of sterile OR drapes following antisepsis of the surgical field.1

Sterile drapes, Equipment cover, Custom procedure trays

Further information

Sterile instruments

  • Instruments coming into contact with the wound or deeper tissue layers must be sterile.1
  • The antiseptic coating on sutures should reduce biofilm formation along the suture.1

Sterile instruments, Antiseptic sutures

Phase 3 postoperative

Further information

Wound dressing

  • Perform the first dressing change after 48h, unless there is evidence of a complication requiring an earlier dressing change.1

Wound dressing: Check wound dressing after 48 hours and perform hygienic dressing change

Further information

Controlled negative pressure therapy (CNP)

  • CNP therapy can be used prophylactically for high-risk wounds with primarily closed incisions and for SSI prevention.2

CNP: Prophylactic negative pressure wound therapy may be used on primarily closed surgical incisions in high-risk wounds and for the purpose of preventing SSI

     
     

Of course all requirements for hygiene remain important while caring for the patient’s wounds and working at the Point of Care!

  1. Prävention postoperativer Wundinfektionen. Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsbl 2018; 61:448–473
  2. Global Guidelines for the Prevention of Surgical Site Infection. World Health Organization 2016. Letzter Zugriff: Februar 2019.
  3. Händehygiene in Einrichtungen des Gesundheitswesens. Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (RKI). Bundesgesundheitsbl 2016; 59:1189–1220

Selection of recommendations for SSI prevention according to Robert Koch Institute, Germany

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