5 Overlooked SSI Prevention Strategies

Colorectal surgery naturally increases the risk of surgical site infections (SSIs) for patients. To address this, the CDC has developed well-established, evidence-based practices specifically aimed at preventing SSIs in these procedures.

Unfortunately, even when incorporated into facility policies, this evidence doesn’t consistently translate across all operating rooms. A group of infection preventionists, including Peter Graves, BSN, RN, CNOR, investigated how a group of hospitals had implemented the 2017 CDC SSI guidelines.

They discovered that barriers to SSI safety practices extended further than expected.

One key finding: While OR leaders authorized the standardized use of triclosan-coated sutures in line with the CDC guidelines, a decision made by someone outside the operating room prevented the standardization of this recommended suture.

Digging deeper, Graves and colleagues found that five of the seven key SSI elements in the CDC guidelines fell well below an acceptable compliance threshold. “Such barriers to safe practices force surgical teams to make choices among various available options, which may contribute to poor patient outcomes and increased costs.”

5 SSI Prevention Strategies

Graves is sharing the study to help surgical teams bridge gaps in SSI prevention practices that can arise between policy, product, purchasing, and frontline care.

Consider these five evidenced-based actions from the CDC guidelines that Graves recommends OR teams need to advocate for to ensure more consistent SSI prevention practices:

1. Use only antimicrobial (triclosan-coated) sutures. This is the simplest and quickest practice in the guideline to implement, Graves says. It’s backed by “a plethora of meta-analyses and studies showing that using this type of suture significantly reduces SSI risk.”
2. Monitor blood glucose levels. Hyperglycemia is a well-known risk factor for SSI. Perioperative team members should ensure that blood glucose is routinely monitored and properly documented throughout a patient’s surgical care.
3. Maintain normothermia. Hypothermia is a risk factor for SSI. So, temperature monitoring devices should be standardized across the perioperative setting to ensure reliability, consistency, and comparability. Patient warming measures should not be discontinued upon admission to the PACU unless the patient is normothermic.
4. Document oxygenation. The study found that postoperative oxygen therapy was frequently discontinued prematurely, creating an unnecessary risk for an SSI. “It’s vital that supplemental oxygen is not discontinued prior to the recommendations outlined in the guidelines for both intraoperative and postoperative patient care.”
5. Implement mechanical bowel preparation and oral antibiotics. “Compliance rates for these practices were notably poor in our study, which was attributed to insufficient documentation and adherence to guideline recommendations.” To improve compliance, have standardized order sets in the EHR, and educate surgeons, physician assistants and nurse practitioners on these practices.

Zero In on Sterile Technique

Beyond just colorectal surgery, every surgical patient is at risk for SSIs if OR teams aren’t following the latest sterile technique practices recommended in AORN’s recent update to the Guideline for Sterile Technique.

Graves called out these two essential safety practices discussed in the AORN guideline:

• Know how often to change surgical gloves
• Always double glove

Because maintaining sterility is crucial for patient safety and infection prevention, Graves urged all nursing leaders and staff “to familiarize themselves with this essential guideline for improving outcomes in all surgical settings.”