17
Table 2. Selected Risk Factors for and Recommendations to
Prevent Surgical Site Infections (SSIs) (continued)
Risk Factor Recommendation
Quality of
Evidence
Extrinsic, procedure related (perioperative)
Operative characteristics
Surgical scrub (surgical
team members' hands
and forearms)
Use appropriate antiseptic agent to perform
preoperative surgical scrub. For most products, scrub
the hands and forearms for 2-5 minutes.
II
Skin preparation Wash and clean skin around incision site. Use a dual
agent skin preparation containing alcohol, unless
contraindications exist.
I
Antimicrobial
prophylaxis
Administer only when indicated. I
Timing Administer within 1 hour of incision to maximize
tissue concentration.
a
I
Choice of
prophylactic agent
Select appropriate agents on the basis of surgical
procedure, most common pathogens causing
SSIs for a specific procedure, and published
recommendations.
I
Duration of
prophylaxis
Stop agent within 24 hours aer the procedure for
all procedures.
II
Blood transfusion Blood transfusions increase the risk of SSI by decreasing
macrophage function. Reduce blood loss and need for
blood transfusion to the greatest extent possible.
II
Surgeon skill/
technique
Handle tissue carefully and eradicate dead space. III
Appropriate gloving All members of the operative team should double-
glove and change gloves when perforation is noted.
III
Asepsis Adhere to standard principles of OR asepsis. III
Operative time No formal recommendation in most recent
guidelines. Minimize as much as possible without
sacrificing surgical technique and aseptic practice.
I
Operating room characteristics
Ventilation Follow American Institute of Architects'
recommendations for proper air handling in the OR.
III
Traffic Minimize OR traffic. III
Environmental
surfaces
Use an EPA-approved hospital disinfectant to clean
visibly soiled or contaminated surfaces and equipment.
III
Sterilization of
surgical equipment
Sterilize all surgical equipment according to
published guidelines. Minimize the use of
immediate-use steam sterilization.
II
a
Vancomycin and fluoroquinolones can be given 2 hours prior to incision.
