Surgical site infection (SSI) is a significant postoperative complication that increases morbidity, mortality, and length of stay for surgical patients[1]. On average, 300,000 to 500,000 people develop SSI annually in the United States[1], with 3% of SSIs being fatal and an overall national cost of $10 billion per year[2]. Reducing the risk of SSI begins with the operating room (OR) team, even before the operation begins.

Here are 5 key points to consider to reduce risk of SSI by promoting collaboration between IPs and the OR:

In a recent AORN (Association of periOperative Registered Nurses) Journal article, Dolores Suslak stated that “Infection prevention staff members must take the time to build relationships with personnel in all perioperative settings to promote safe patient care and to provide specific guidance that drives best practices” [4]. It is crucial that a surgical team know their Infection Preventionist’s (IP) name and the value of the knowledge/expertise they possess in order to turn to this person with IP‐related questions. Being a confident and active presence as an IP leads to a fuller understanding of the OR culture. Reporting, questioning, and confirming best practices through constructive feedback can improve infection prevention care.

IPs should possess key areas of knowledge to be helpful in the OR. These domains include but are not limited to SSI surveillance methods, SSI prevention bundles, central processing principles and practices, and current AORN practices. Having a firm grasp on these areas strengthens team engagement and delivery of best practices.

OR culture and infection prevention practices should be evaluated continuously for effectiveness. Staff transparency, team structure, decision‐making processes, and surgical equipment should be assessed regularly in order for members to express concerns or highlight unusual aspects of an impending procedure or patient. In the same AORN Journal article mentioned earlier, Dolores Suslak highlights that “A new set of eyes will often detect subtle risks that may be overlooked by staff members who see the same equipment daily” (4). This advice can be applied to every stage of the OR process. Furthermore, the IP should attend surgical practice meetings and a surgical team member should be present on the Infection Control Committee to promote effective and timely exchange of information regarding best practices. An IP’s periodic presence in the OR contributes to and reinforces this constant evaluation for improvement.

SSI prevention begins with the patient’s maintainable defenses. Preventing blood loss in the OR helps avoid immunosuppressive effect of blood transfusions while glycemic control promotes wound healing and improves white blood cell function.

Normothermia must be maintained; patients must be kept warm so they don’t enter the OR cold where recovering from heat loss is difficult. Pre‐op nutritional support for the patient can enhance surgical recovery by boosting immune system response and tissue repair.

Minimizing wound contamination by performing certain interventions can reduce SSI risk. Surgical hand scrubs reduce hand flora while covering skin and hair with sleeves and surgical masks/gloves all reduce skin shedding. Controlling OR air quality filtration with laminar flow and reducing traffic within the OR reduce contaminants. Also, prepping the patient’s skin with alcohol‐based skin antiseptic agents or iodine to reduce skin flora provides a decontaminated surface for incision with previously sterilized instruments. In an article in the American Journal of Infection Control, Mana reiterates that “currently, there is no standard of practice for postoperative wound care and the choice of dressing remains physician preference” (1). IPs have to collaborate with the OR on steps to maintain a decontaminated wound postoperatively to optimize patient recovery.

There is always some level of bacterial inoculation that occurs during a surgical procedure (3). To minimize SSI risk, these 5 considerations can improve infection prevention practices for the IP while promoting OR collaboration.

For more information about preventing SSI, please review the cited articles below:

The Wisconsin Department of Health Services, Division of Public Health Supplemental Guidance for the Prevention of Surgical Site Infections: An Evidence-Based Perspective

1.Mana et al. Preliminary analysis of the antimicrobial activity of a postoperative wound dressing containing CHG against MRSA in an in vivo porcine incisional wound model. American Journal of Infection Control, September 2019. https://www.ajicjournal.org/article/S0196‐6553(19)30572‐3/pdf

2. Wisconsin Division of Public Health Supplemental Guidance for the Prevention of Surgical Site Infections: An Evidence‐Based Perspective, 2017 https://www.dhs.wisconsin.gov/publications/p01715.pdf

3. Borlaug, G. (September, 2019) The Role of the Infection Preventionist in Preventing Surgical Site Infections: How to Develop Effective Partnerships with the Surgical Care Team [Webinar].

4. Suslak, D. Partnering With Perioperative Colleagues to Prevent Infection. AORN Journal, November, 2017. https://aornjournal.onlinelibrary.wiley.com/doi/10.1016/j.aorn.2017.10.007. Accessed November 2019.