Surgical Best Practices for Infection Prevention

The goal of surgical best practices is to prevent surgical site infections (SSIs), which can be triggered by contamination from the surgical instrument or by skin flora at the incision site, as well as by bacterial cross-contamination or by surgical hypothermia.

Brennan, et al. (1991) note that SSIs are the second most common type of adverse events occurring in hospitalized patients, while Kirkland, et al. (1999) observe that SSIs have been shown to increase mortality, readmission rate, length of stay and costs. According to the Institute for Healthcare Improvement (IHI), an estimated 40 percent to 60 percent of these infections are preventable, and that implementing several components of care — such as appropriate use of prophylactic antibiotics, appropriate hair removal and maintaining normothermia — can help reduce SSIs.

Bratzler, et al. (2005) conducted a review of 34,133 charts for the Centers for Medicare & Medicaid Services (CMS) that indicated significant opportunity for improvement in SSI prevention. Bratzler, et al. found that appropriate antibiotic selection occurred in 92.6 percent of cases; antibiotics were given within one hour of incision time to 55.7 percent of patients; and prophylactic antibiotics were discontinued within 24 hours of surgery end time for only 40.7 percent of patients.